second stage of labor

Question 1

definition

Answer 1

• second stage of labour ( expulsive stage ) begins from full cervical dilation to delivery of the fetus. It can be divided into ( in vertex presentation )
  i) delivery of the head
  ii) delivery of the shoulder
  iii) delivery of body + legs

Duration:
Prima para – 1hr ( < 2hr )
Multi para – 20 – 30 min

Question 2

types of episiotomy

Answer 2

• episiotomy is a surgical incision of the pudendal region to increase the diameter of the vulvular opening + prevent lacerations of maternal tissue + fetal head
• its is done when the PP begins to distend the perineum / crowning occurs.
• There are 2 types :
  1. median episiotomy / midline – incision is made in the midline
  2. mediolateral episiotomy – incision is made down + directed laterally away from the rectum

Question 3

advantages of episiotomy

Answer 3

1. prevent perineal laceration
2. relieve compression of fetal head, enables application of forceps
3. decrease length of 2nd stage beczuse of decrease resistance of pudendal muscle
4. surgical incisions can be repaired better than a jogged tear

Question 4

medial episiotomy and mediolateral episiotomy

Answer 4

Medial episiotomy Mediolateral episiotomy

Easier to repair More difficult to repair

PO pain is minimal Common

Anatomical results are excellent Occasionally faulty

Less blood lost More blood lost

Rare dysproteinuria Occasional

Extensions common Uncommon

Question 5

disadvantages

Answer 5

1. increased blood loss
2. Greater incidence of extension to 3 - 4th degree laceration
3. more pain in post partum period
4. anymore???