Second Stage of Labor Flashcards
second stage
begins w/ complete dilation and ends w/ fetal expulsion
What is the average length of the second stage?
prim: 46mins (Friedman)/1.75-2.75h (current)
multip: 14mins (Friendman)/1-2h (current)
What factors influence duration of the second stage?
- parity
- fetal position
- epidural
- fetal station at complete dilation
- first-stage labor dystocia
- uterine contraction activity
- +/- infection
- maternal pushing efforts
- pelvic architecture
- birth weight
- maternal weight/BMI
- induction of labor
- maternal fear/anxiety
- maternal pain/discomfort
- maternal hx abuse/trauma
How is prolonged second stage defined?
No progress in descent and rotation for:
- > /= 4h in nullips w/ epidural
- > /= 3h in nullips w/out epidural
- > /= 3h in multips w/ epidural
- > /= 2h in multips w/out epidural
What are the 5 Ps?
1) powers (contractions)
2) passenger (fetus)
3) passageway (pelvis)
4) position (maternal/fetal)
5) psyche (and/or people)
How often should FHT be measured?
q5-15mins
How often should vitals be measured?
BP: q15mins
T, HR, RR: q1h
What are techniques used while pushing?
- passive descent AKA laboring down
- open glottis
- spontaneous pushing = supportive, physiologic
List non-pharm comfort measures
- intradermal sterile water
- hydrotherapy
- acupuncture/massage
- relaxation techniques
- positioning
- cool/hot packs
- doula/labor support
- TENS unit
- music
List pharm comfort measures
- pudendal block
- nitrous oxide
- IV opiates
- epidural
- sedatives/hypnotics
What are contraindications to a pudendal block?
- coagulation disorder
- vaginal infection
- allergy (1% lidocaine HCl)
What are opiates are most commonly used during labor?
- morphine
- fentanyl - short half life –> no neonatal respiratory depression
first degree laceration
involves perineal skin
second degree laceration
Involves
- skin, vaginal mucosa, posterior fourchette; extends into peineal body fascia and musculature
- superficial and deep transverse perineal muscle and fibers of pubococcygeus and bulbocavernosus
DOES NOT involve anal sphincter
third degree laceration
inclusive of second degree + OASIS = obstetric anal sphincter injuries
- 3a: <50% of external anal sphincter
- 3b: >50% of external anal sphincter
- 3c: complete rupture of external anal sphincter AND internal anal sphincter is torn
fourth degree laceration
inclusive of third degree + internal anal sphincter AND anterior rectal mucosa
Which positions decrease tearing?
- side-lying
- semi-upright
Which positions increase tearing?
- upright or squatting
- lithotomy
What are indications for an episiotomy?
- suspicious FHT
- operative delivery
- shoulder dystocia
Describe the Ritgen maneuver
Using finger to hook fetal chin to expedite birth
What are the cardinal movements of labor?
1) engagement
2) descent
3) flexion
4) internal rotation
5) extension
6) restitution
7) external rotation
8) delivery of posterior shoulder by lateral flexion
