Second Stage of Labor

Question 1

second stage

Answer 1

begins w/ complete dilation and ends w/ fetal expulsion

Question 2

What is the average length of the second stage?

Answer 2

prim: 46mins (Friedman)/1.75-2.75h (current)
multip: 14mins (Friendman)/1-2h (current)

Question 3

What factors influence duration of the second stage?

Answer 3

• 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

Question 4

How is prolonged second stage defined?

Answer 4

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

Question 5

What are the 5 Ps?

Answer 5

1) powers (contractions)
2) passenger (fetus)
3) passageway (pelvis)
4) position (maternal/fetal)
5) psyche (and/or people)

Question 6

How often should FHT be measured?

Answer 6

q5-15mins

Question 7

How often should vitals be measured?

Answer 7

BP: q15mins

T, HR, RR: q1h

Question 8

What are techniques used while pushing?

Answer 8

• passive descent AKA laboring down
• open glottis
• spontaneous pushing = supportive, physiologic

Question 9

List non-pharm comfort measures

Answer 9

• intradermal sterile water
• hydrotherapy
• acupuncture/massage
• relaxation techniques
• positioning
• cool/hot packs
• doula/labor support
• TENS unit
• music

Question 10

List pharm comfort measures

Answer 10

• pudendal block
• nitrous oxide
• IV opiates
• epidural
• sedatives/hypnotics

Question 11

What are contraindications to a pudendal block?

Answer 11

• coagulation disorder
• vaginal infection
• allergy (1% lidocaine HCl)

Question 12

What are opiates are most commonly used during labor?

Answer 12

• morphine

- fentanyl - short half life –> no neonatal respiratory depression

Question 13

first degree laceration

Answer 13

involves perineal skin

Question 14

second degree laceration

Answer 14

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

Question 15

third degree laceration

Answer 15

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

Question 16

fourth degree laceration

Answer 16

inclusive of third degree + internal anal sphincter AND anterior rectal mucosa

Question 17

Which positions decrease tearing?

Answer 17

• side-lying

- semi-upright

Question 18

Which positions increase tearing?

Answer 18

• upright or squatting

- lithotomy

Question 19

What are indications for an episiotomy?

Answer 19

• suspicious FHT
• operative delivery
• shoulder dystocia

Question 20

Describe the Ritgen maneuver

Answer 20

Using finger to hook fetal chin to expedite birth

Question 21

What are the cardinal movements of labor?

Answer 21

1) engagement
2) descent
3) flexion
4) internal rotation
5) extension
6) restitution
7) external rotation
8) delivery of posterior shoulder by lateral flexion