second stage of labour

Question 1

give a definition of the second stage of labour

Answer 1

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

Question 2

what happens between the 1 and 2 stage

Answer 2

physiological changes occur- transitional changes

Question 3

are there any signs to signify the changing of stages

Answer 3

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

Question 4

what is the appearance of the presenting part

Answer 4

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

Question 5

how many stages dose the 2 stage of labour have

Answer 5

2

Latent and active

Question 6

what happens in the latent phase of the 2 stage

Answer 6

begins at full dilation, presenting part may be visible,

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

Question 7

what happens in the active phase

Answer 7

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

Question 8

what is maternal pushing a sign of

Answer 8

active phase

Question 9

what are the 3 main process involved in the second stage

Answer 9

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

Question 10

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

Answer 10

often lull before they become expulsive in nature

Question 11

what are contractions like in the 2 stage

Answer 11

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

Question 12

what are secondary powers

Answer 12

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

Question 13

what dose fetal axis pressure cause

Answer 13

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

Question 14

what causes fetal axis pressure

Answer 14

the fetus descending the birth canal

Question 15

can the fetal axis pressure help the baby

Answer 15

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.

Question 16

what can aid in fetal axis pressure

Answer 16

optimized by upright positions- mother standing/sitting up straight

Question 17

what issue can stop the mechnisms of labour

Answer 17

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

Question 18

what is the mechanism of labour

Answer 18

movments of the fetus to move through the birth canal

Question 19

what are the Common mechanisms for normal labour

Answer 19

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

Question 20

what are the movments involved in mechanism of labour

Answer 20

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.

Question 21

what is the Anterior fontanelle

Answer 21

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

Question 22

what is the Posterior fontanelle

Answer 22

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

Question 23

what is the Bi parietal diameter

Answer 23

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

Question 24

what influences the degree of flexion or extension of the head

Answer 24

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

Question 25

where is the Submentobregmatic measured to and from

Answer 25

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

Question 26

when dose the Submentobregmatic measurement engage

Answer 26

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

Question 27

where is the Suboccipitobregmatic measures to and from

Answer 27

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

Question 28

when dose the Suboccipitobregmatic engage

Answer 28

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

Question 29

when dose the Occipitomental | present

Answer 29

Presents in a brow presentation where the head is part flexed

Question 30

when dose the Occipitofrontal present

Answer 30

Presents when ther is insufficient flexion of the head. | Results in persistent OP / face to pubes.

Question 31

can fetus brains flex

Answer 31

Yes they can flex. it is called moulding

Question 32

what is the advantage of flex in a feteus head

Answer 32

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

Question 33

by who much can the fetus head flex/mould

Answer 33

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

Question 34

how can the fetus head mould/flex

Answer 34

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

Question 35

when and why dose desent occur

Answer 35

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

Question 36

when is descent speeded up

Answer 36

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

Question 37

what determines which diameter will present in labour

Answer 37

The attitude (flextion)determines this

Question 38

what occurs to the flextion of a babies head in labour

Answer 38

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

Question 39

why dose crowning occur

Answer 39

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

Question 40

what is Restitution

Answer 40

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

Question 41

how do the shoulders rotate

Answer 41

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

Question 42

what happens when the internal shoulders rotate

Answer 42

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

Question 43

what occurs in Lateral flexion

Answer 43

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

Question 44

name three Malpresentations of the fetal head

Answer 44

Primary face presentation secondary face presentations Brow presentation

Question 45

what is face presentations

Answer 45

Occurs when the head and neck are hyperextended but limbs flexed so baby lying in an S shape. Presenting part is therefore the chin

Question 46

when dose primary F presentation occur and what are the causes

Answer 46

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

Question 47

when dose secondary F presentation occur and its causes

Answer 47

``` develop in labour: Deflexed OP position Uterus laxity Flat pelvis Prematurity Polyhydramnios Multiple pregnancy ```

Question 48

what position must the chin be in to be delivery vaginally

Answer 48

Chin must be anterior to deliver vaginally

Question 49

when dose Brow presentation occur and its causes

Answer 49

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

Question 50

in which presentation is C-section often used

Answer 50

Brow presentation

Question 51

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

Answer 51

3 stage

Question 52

name two approached to labour management in the third stage

Answer 52

active and physilogical

Question 53

what is active management

Answer 53

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

Question 54

what is physiological management of the third stage

Answer 54

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

Question 55

what are some signs of the third stage

Answer 55

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

Question 56

when should the third stage occur

Answer 56

30 mins after delivery of baby

Question 57

what is a lotus birth

Answer 57

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

Question 58

what is the risk of a lotus birth

Answer 58

Risks of infection remain for the baby

Question 59

what is Placentophagy

Answer 59

eating the plecenta- made into pills