Transition and the Second Stage

Question 1

transitional stage labour usually begins ?cm onwards:

Answer 1

8cm
(the period where the first stage of labour transitions into the second stage)

commonly only lasts a couple of contractions

Question 2

what hormone peaks during the transitional stage of labour?

Answer 2

adrenaline

primitive safety mechanism to produce surge of energy

Question 3

what are some common behaviours of women during the transitional stage of labour?

Answer 3

restlessness/thrashing
urge to bear down/push
shaking
uncharacteristic distress/fear of death

Question 4

the second stage of labour is the period of time between full ? and ?:

Answer 4

between full cervical dilatation and birth of baby

in which women have an involuntary urge to bear down as a result of uterine contractions

Question 5

the passive second stage of labour:

Answer 5

full dilatation of the cervix before involuntary expulsive contractions

Question 6

the active second stage of labour:

Answer 6

baby is visible

expulsive contractions with full dilatation of cervix

Question 7

the passive second stage of labour is also known as:

Answer 7

‘rest and be thankful’ stage

women becomes more drowsy and relaxed as contractions appear to fade

Question 8

soft tissues are displaced during the second stage of labour:

Answer 8

bladder displaces anteriorly
rectum flattens and dilates
perineal body thins

Question 9

what are some signs women are in the second stage of labour?

Answer 9

need to push from woman
vomiting
powerful expulsive contractions (lasting at least 60 seconds)
rectal pressure
anal dilatation
appearance of presenting part
purple line
SROM (if not happened already)

Question 10

rhomboid of michaelis:

Answer 10

sign a woman is about to give birth

prominent sacrum as pelvis moves to allow baby to descend

Question 11

how long would the second stage of labour last on average for a nulliparous woman?

Answer 11

birth should take place within 3 hours

operative vaginal birth may be considered from 2 hours onwards

Question 12

how long would the second stage of labour last on average for a multiparous woman?

Answer 12

birth should take place within 2 hours

operative vaginal birth may be considered from 1 hour onwards

Question 13

during the second stage of labour the frequency of contractions should be documented:

Answer 13

at least every 30 minutes

Question 14

during the second stage of labour blood pressure should be taken:

Answer 14

at least every hour

Question 15

a vaginal examination can be offered ? in the second stage of labour:

Answer 15

hourly

Question 16

how do we assess fetal wellbeing during the second stage of labour?

Answer 16

auscultating fetal heart rate
assessing colour of liquor
checking position of presenting part (at least hourly but depends on VEs)

Question 17

what positions should be discouraged during second stage of labour?

Answer 17

lying supine or semi-supine

Question 18

‘Valsalva’s manoeuvre’:

Answer 18

directed pushing
also known as ‘cheerleading’

can reduce oxygenation to the fetus and results in increased frequency of trauma to the birth canal

Question 19

‘hands on’ guarding of the perineum:

Answer 19

recommended by WHO

touching and guarding the perineum and flexing the baby’s head

Question 20

‘hands poised’ guarding of the perineum:

Answer 20

hands are off the perineum but are ready

technique used to facilitate spontaneous birth

Question 21

the RCOG support the idea of MPP:

Answer 21

manual perineal protection:

one hand on babys head at crowning to slow entrance and applying small pressure
other hand guarding perineum