Second stage of labour (Complete)

Question 1

What is the second stage of labour?

Answer 1

Stage of labour beggining from completion of cervical dilation to 10cm until delivery of foetus

Question 2

What are the main steps in second stage of labour?

Answer 2

Engagement

• Widest part of head enters pelvic inlet at level of ischial spines

Descent

• Descending of foetal head further down pelvic cavity

Flexion

• Presenting of the smallest diameter of the head (due to flexion of chin onto chest)

Internal rotation

• Turning of the head so occiput lines up with mother’s pelvis

Extension

• Extension of head to pass pubic symphysis resulting in presentation of crown followed by forhead, face and then chin

Restitution

• Head rotates to realign with shoulders

Delivery of shoulders

• Anterior shoulder followed by posterior shoulder

Expulsion

• Complete delivery

Question 3

Widest part of head (biparietal diameter) enters the pelvic inlet

Answer 3

Engagement

Question 4

Descending of foetal head further down the pelvic cavity

Answer 4

Descent

Question 5

Flexion of chin onto chest causing presentation of smallest diameter of head (suboccipitobregmatic diameter)

Answer 5

Flexion

Question 6

Rotation of foetal head so occiput aligns with maternal pelvis

Answer 6

Internal rotation

Question 7

Extension of head causing the crown of the head to present, followed by the forehead, face and then chin

Answer 7

Extension

Question 8

Rotation of head to align with shoulders

Answer 8

Restitution (external rotation of head)

Question 9

What is considered prolonged delivery in nulliparous women?

Answer 9

No epidurla: > 2 hours

With epidural: > 3 hours

Question 10

What is considered prolonged delivery in multiparous women?

Answer 10

Without epidural: > 1 hour

With epidural: > 2 hours

Question 11

What factors are associated with prolonged labour?

Answer 11

Maternal factors:

Inadequate pushing effort (exhaustion)

Cephalopelvic disproportion

Dehydration & maltnutrition

Foetal factors:

Macrosomia

Malposition (fetus is presenting vertex but not in ideal position)

Malpresentation (fetus not in vertex position)

Labour factors:

• Epidural anaesthesia (can delay descent)

Question 12

Why is there more leeway for classifying labour as prolonged in patients with epidural anaesthesia?

Answer 12

Can cause delay in descent

Question 13

How are patients undergoing prolonged second stage of labour managed?

Answer 13

Instrumental delivery:

Ventouse suction cups

Forceps

Question 14

Give 2 examples of types of instrumental delivery

Answer 14

Ventouse suction cups

Forceps

Question 15

What complications are associated with forceps delivery?

Answer 15

Maternal:

Increased risk of perineal trauma

Risk of damage to the femoral or obturator nerves

Foetal:

Contusions

Skull fractures

Facial nerve palsy (due to compression)

Question 16

What complications are associated with vacuum delivery?

Answer 16

Cephalhaematoma

Subgaleal haematoma

Less succesful than forceps but has less complications

Question 17

What alternative option is available for instrumental delivery is contraindicted?

Answer 17

C-section

C-section in this stage of labour is associated with increased maternal mrobidity

Question 18

What maternal complications can arise due to prolonged labour?

Answer 18

Perineal trauma

Postpartum haemorrhage

Infection (chorioamnionitis or endometritis)

Maternal exhaustion

Question 19

What foetal complications can arise due to prolonged labour?

Answer 19

Foetal distress

Birth trauma (e.g. brachial plexus injury)

Increased risk of hypoxia or acidosis