January 16, 2014

Management of second stage of labour

Principles -
1. To assist in the natural expulsion of the fetus slowly and steadily.
2. To prevent perineal injuries.

General measures -
- The patient should be in bed.
- Constant supervision is mandatory and the FHR is recorded at every minutes.
- To administer inhalation analgesics, if available, in the form of Gas  N2O  and  O2  to
  relieve pain during contractions.
- Vaginal examination is done at the beginning of the second stage not only to conform
  its onset but to detect any accidental cord prolapse.

Preparation for delivery -
- Position :- Positions of the woman during delivery may be lateral or dorsal.
- The accoucheur scrubs up and puts on sterile gown, mask and gloves and stands on
  the right side of table.
- Toileting the external genitalia and inner side of the thighs is done with cotton swabs
  soaked in Savlon and or Dettol solution.
- Essential aseptic procedures are remembered as 3 'C's -
                       - Clean hands  
                       - Clean surface
                       - Clean cutting and ligaturing of the cord
- To catheterise the bladder, if it is full.

Conduction of delivery -
The assistance required in spontaneous delivery. It divided into three phases -
                       - Delivery of the head
                       - Delivery of the shoulders
                       - Delivery of the trunk
For details, visit the page Delivery of the baby.

Immediate care of the newborn -
-  Soon after the delivery of the baby, it should be placed on a tray covered with clean dry
   linen with the head slightly downwards. It facilitates drainage of the mucus accumulated
   in the trachco-bronchial tree by gravity. The tray is placed between the legs of the mother
   and should be at a lower level than the uterus to facilitate gravitation of blood from the 
   placenta to the infant.
-  Air passage should be cleared of mucus and liquor by gentle suction.
-  Apgar rating at one minute and at five minutes is to be recorded.
-  Clamping and ligature of the cord - The cord is clamped by two Kocher's forceps, the near
   one is placed 5 cm away from the umbilicus and is cut in between. The cut end is then
   covered with sterile gauze piece after making sure that there is no bleeding. The purpose 
   of clamping the cord on the maternal end is to prevent soiling of the bed with blood.

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