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Physiology > second stage of labour > Flashcards

second stage of labour Flashcards

1
Q

give a definition of the second stage of labour

A

the period of full dilation of the cervix to the expulsion/birth

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2
Q

what happens between the 1 and 2 stage

A

physiological changes occur- transitional changes

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3
Q

are there any signs to signify the changing of stages

A 
no clear signs,
bunch of signs togerther may notify this
waters breaking,
dilation +gaping of anus
anal cleft#
Rhomboid of michaelis
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4
Q

what is the appearance of the presenting part

A

conclusive sign of 2 stage
Exsessive moulding ad caput succedabeum formation may protrude through cervix before full dilation
often seen as bleeding due to separation of Plecenta

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5
Q

how many stages dose the 2 stage of labour have

A

2

Latent and active

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6
Q

what happens in the latent phase of the 2 stage

A

begins at full dilation, presenting part may be visible,

head begins to descend due to force of contractions and stretching of the tissue,

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7
Q

what happens in the active phase

A

once the head is visable, pressure reterns to normal, causes reflex stimuli for maternal explsion pushing what starts the active phase

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8
Q

what is maternal pushing a sign of

A

active phase

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9
Q

what are the 3 main process involved in the second stage

A

1-contractions
2- secondary powers- the passenger (pelvis)
3- fetal axis pressure- passenger- fetus

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10
Q

what happens to contractions at the end of the 1st stage

A

often lull before they become expulsive in nature

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11
Q

what are contractions like in the 2 stage

A

become longer and stronger but may be less frequent so that the woman and her baby can recover between each expulsive effort

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12
Q

what are secondary powers

A

in active phase- pressure causes pushing reflex, fetus is compacted in contractions, spontaneous pushing is best

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13
Q

what dose fetal axis pressure cause

A

diplacment of soft tissue in pevis
bladder push up
fecal matter can be released due to rectum flatterned
levator ani muscles of the pelvic floor thin out and are displaced laterally
perineal body is stretched and thinned

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14
Q

what causes fetal axis pressure

A

the fetus descending the birth canal

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15
Q

can the fetal axis pressure help the baby

A

can aid descent
increased flexion of the head which results in smaller presenting diameters, more rapid progress and less trauma to the mother and fetus.

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16
Q

what can aid in fetal axis pressure

A

optimized by upright positions- mother standing/sitting up straight

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17
Q

what issue can stop the mechnisms of labour

A

curve of birth canal, large size baby head can also be an issue

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18
Q

what is the mechanism of labour

A

movments of the fetus to move through the birth canal

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19
Q

what are the Common mechanisms for normal labour

A

The lie is longitudinal.
• The attitude is one of good flexion.
• The presentation is cephalic.
• The position is right or left occipitoanterior.
• The denominator is the occiput.
• The presenting part is the posterior part of the anterior parietal bone

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20
Q

what are the movments involved in mechanism of labour

A 
Descent.
• Flexion.
• Internal rotation of the head.
• Crowning and extension of the head.
• Restitution.
• Internal rotation of the shoulders and external rotation of the head.
• Lateral flexion.
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21
Q

what is the Anterior fontanelle

A

: A diamond shaped structure connecting 4 sutures. 2.5cm across 3cm long
on the top of the head near the front

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22
Q

what is the Posterior fontanelle

A

triangular in shape.
Presents when head well flexed
near the back of the head

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23
Q

what is the Bi parietal diameter

A

Widest part of fetal skull. Crowning occurs when this is delivered

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24
Q

what influences the degree of flexion or extension of the head

A

The presentation and position of the fetal head in relation to the pelvic brim

25
Q

where is the Submentobregmatic measured to and from

A

Measured from the junction of the chin with the neck to the centre of the anterior fontanelle

26
Q

when dose the Submentobregmatic measurement engage

A

This diameter engages when the head is fully engaged in a face presentation

27
Q

where is the Suboccipitobregmatic measures to and from

A

Measured with the junction of the head with the neck to the centre of the anterior fontanelle

28
Q

when dose the Suboccipitobregmatic engage

A

Presents when the fetal head is flexed. Optimum diameter for labour
May result in normal moulding / caput

29
Q

when dose the Occipitomental

present

A

Presents in a brow presentation where the head is part flexed

30
Q

when dose the Occipitofrontal present

A

Presents when ther is insufficient flexion of the head.

Results in persistent OP / face to pubes.

31
Q

can fetus brains flex

A

Yes they can flex. it is called moulding

32
Q

what is the advantage of flex in a feteus head

A

adapting to prolonged compression in order to enhance passage through the birth canal

33
Q

by who much can the fetus head flex/mould

A

Moulding can increase /decrease diameters of head by up to 1.5cm
changes shape but not volume

34
Q

how can the fetus head mould/flex

A

the frontal bones move under the anterior aspects of the parietal bones and the occiput moves under the parietal bones at the back

35
Q

when and why dose desent occur

A

may have occurred in the antenatal period, so that the head is engaged-
sagittal suture is in the transverse diameter of the pelvis

36
Q

when is descent speeded up

A

continued descent during the first stage of labour and this is speeded up by maternal effort during the 2nd stage of labour

37
Q

what determines which diameter will present in labour

A

The attitude (flextion)determines this

38
Q

what occurs to the flextion of a babies head in labour

A

increases in labour, due to Pressure transmitted from the fundus of the uterus down the fetal spine

39
Q

why dose crowning occur

A

this occurs when the head is visable and is no longer affected by contractions. it pivots on the suboccipital region around the pubic bone

40
Q

what is Restitution

A

movement made by the head following delivery which brings it into correct alignment with the shoulders

41
Q

how do the shoulders rotate

A

anterior shoulder is the first to reach the pelvic floor and this now rotates forward to lie under the symphysis pubis. This movement is accompanied by external rotation of the head

42
Q

what happens when the internal shoulders rotate

A

The occiput now lies laterally, turned towards the woman’s thigh

43
Q

what occurs in Lateral flexion

A

the spine bends laterally on its way through the curved birth canal, once the shoulders are out

44
Q

name three Malpresentations of the fetal head

A

Primary face presentation
secondary face presentations
Brow presentation

45
Q

what is face presentations

A

Occurs when the head and neck are hyperextended but limbs flexed so baby lying in an S shape.

Presenting part is therefore the chin

46
Q

when dose primary F presentation occur and what are the causes

A

occurs before labour and has recognised causative factors:
Anencephaly – no vertex to present
Tumours of fetal neck preventing flexion
Excessive tone in fetal extensor muscles

47
Q

when dose secondary F presentation occur and its causes

A 
develop in labour:
Deflexed OP position
Uterus laxity
Flat pelvis
Prematurity
Polyhydramnios
Multiple pregnancy
48
Q

what position must the chin be in to be delivery vaginally

A

Chin must be anterior to deliver vaginally

49
Q

when dose Brow presentation occur and its causes

A

The least common presentation
Head is midway between flexion and extension.
Causes: cephalopelvic disproportion
fetal prematurity
increasing parity
C-section often used in this presentation

50
Q

in which presentation is C-section often used

A

Brow presentation

51
Q

in what stage is the placenta and it’s membranes expelled

A

3 stage

52
Q

name two approached to labour management in the third stage

A

active and physilogical

53
Q

what is active management

A 
administer drugs 
clamp and cut umblical cord 
brace utrus 
controlled cord traction to 
expedite delivery of the 
placenta and membranes
54
Q

what is physiological management of the third stage

A

No drugs
no cord clamping, until p is delivered
no cord traction

55
Q

what are some signs of the third stage

A

gush of blood
cord lengthening
globular+ firm utrus, uturs rises

56
Q

when should the third stage occur

A

30 mins after delivery of baby

57
Q

what is a lotus birth

A

parents carry around placenta still connected to baby until it naturally falls off

58
Q

what is the risk of a lotus birth

A

Risks of infection remain for the baby

59
Q

what is Placentophagy

A

eating the plecenta- made into pills

Physiology (10 decks)

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