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management of second stage of labour 12 January/2021

During the second stage, delaying pushing for 1–2 hours or until the woman has a strong urge to push reduces the need for rotational and midcavity interventions [4]. AIM • To recognise and support normal second stage of labour • To make a timely diagnosis of delay in the second stage of labour and … This is usually the longest stage of labour. Steps of Management of the Second Stage of Labour . Stage. Labour has three stages: The first stage is when the neck of the womb opens to 10cm dilated.The second stage is when the baby moves down through the vagina and is born.The third stage is when the placenta (afterbirth) is delivered.Labour and birth are intense and personal experiences. Since a randomized controlled trial would not be ethical or feasible, a retrospective, case–control study or observational study would be the preferred study design. Modifiers that affect the second stage length include factors such as parity, epidural anesthesia, delayed pushing, fetal station at complete dilation, maternal body mass index, fetal weight and occiput posterior (OP) position1. General measures - - The patient should be in bed. Management of the second stage of labor often follows tradition‐based routines rather than evidence‐based practices. You do not currently have access to this tutorial. Optimization of the second stage of labor is essential to ensure safe maternal and fetal outcomes. European Journal of Obstetrics & Gynecology and Reproductive Biology. Furthermore, a policy of routine episiotomy is more costly [20]. It is thought that lack of attention to humanistic care and respect for even “mainstream” cultural preferences by maternity care providers is a major barrier to the utilization of health facilities in many countries, as reflected in health surveys that show reasonable uptake of antenatal care but low rates of delivery in health facilities. However, median episiotomy is also associated with a higher risk of injury to the maternal anal sphincter and rectum than mediolateral episiotomies or spontaneous obstetric lacerations [22]. Relatively little thought or teaching seems to be devoted to the third stage of labor compared with that given to the first and second stages. Mediolateral episiotomy is recommended for instrumental vaginal delivery [23]. Where and how an attendant is trained and the rationale for the episiotomy often dictate which of the 3 main types of episiotomy—mediolateral, median, J‐shaped—is performed. Uterine contractions are checked. Episiotomy and laceration repair should always be performed under adequate perineal anesthesia. There have been challenges to the concept that the exact timing of the 2nd stage of labour is possible and progress rather than an estimated time limit is … UK prices shown, other nationalities may qualify for reduced prices. The Journal of Maternal-Fetal & Neonatal Medicine. Wide availability of robust handheld Doppler devices with battery backup and/or wind‐up recharging technology should be part of standard equipment provision for safe maternity care. Management of the passive phase of the second stage of labor in nulliparous women - focus group discussions with Swedish midwives. While the traditional Pinard stethoscope (fetoscope) may be adequate in very quiet labor rooms, it is often difficult to use reliably owing to surrounding noise or maternal obesity, and especially in the second stage because of the woman's naturally vigorous movements. Third Stage of Labour - Management Uncontrolled document when printed Published: 27/07/2020 Page 2 of 5 preferred oxytocic for women at higher risk of postpartum haemorrhage, such as: Previous history of PPH greater than 1 litre Previous history of retained placenta Prolonged use of oxytocin infusion for induction or augmentation of labour (greater than 8 hours) Prolonged active second stage … Position in the second stage of labour for women without epidural anaesthesia. The skilled attendant also has the role of encouraging the mother to adopt positions for active pushing that are culturally appropriate, comfortable, and mechanically beneficial; for example, squatting or sitting up as opposed to lying flat on a bed. Update on Maternal Mortality in the Developed World, https://doi.org/10.1016/j.ijgo.2012.08.002, http://whqlibdoc.who.int/publications/2004/9241591692.pdf, http://whqlibdoc.who.int/publications/2007/9241545879_eng.pdf, http://www.who.int/healthsystems/TTR‐TaskShifting.pdf, http://www.nice.org.uk/nicemedia/pdf/IPCNICEGuidance.pdf, http://whqlibdoc.who.int/publications/2009/9789241547734_eng.pdf, http://www.childinfo.org/files/maternal_mortality_finalgui.pdf. Ex officio: G. Serour, FIGO President; H. Rushwan, FIGO Chief Executive; C. Montpetit, SMNH Committee Coordinator. When reviewing compliance with the current second stage management duration guidelines as determined by ACOG, SMFM and NICHD1,2, UWMC is 100% at goal for time allowance prior to cesarean section. Advanced Second Stage Skills management of 2nd stage of labour. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username. Prolonged labour is associated with increased risk of postpartum haemorrhage (PPH), but the role of active pushing time and the relation with management during labour remains poorly understood. A leading North American obstetrics text devotes only 4 of more than 1500 pages to the third stage of labor but significantly more to the complications that m… Advanced Second Stage Skills management of 2nd stage of labour. The Third Stage of Labour is the period during which the woman's body pushes out the baby's placenta. To achieve this, health facilities providing maternity care need to structure their staff allocation and skill mix to recognize the extra care needs of mothers in the second stage. Postpartum haemorrhage is one of the leading causes of maternal death worldwide; it occurs in about 10.5% of births and accounts for over 130 000 maternal deaths annually.1 Active management of the third stage of labour is highly effective at preventing postpartum haemorrhage among facility-based deliveries. In the early part of labour, the patient may be allowed injectible analgesics, but these may cause depression of the baby and is best avoided if there are less than 3 hours before delivery. Response. Labour: Second stage Management Page 4 of 5 Obstetrics & Gynaecology 5. Health facilities and skilled attendants should be provided with handheld battery powered or hand‐cranked Dopplers for fetal heart auscultation after every contraction. Use of upright or lateral positions during delivery compared with supine or lithotomy (18 trials; n = 5506; RR 0.84, 95% CI, 0.73–0.98) [10]. Exploring full cervical dilatation caesarean sections–A retrospective cohort study. Number of times cited according to CrossRef: Why do women assume a supine position when giving birth? In the absence of the urge to push and in the presence of a normal fetal heart rate, care providers should wait before encouraging active pushing in primiparous women and women who have had an epidural for up to but not longer than 4 hours, and in multiparous women for up to but not longer than 1 hour [5], [6]. Arrangements for having another person besides the primary skilled attendant should be planned during the pregnancy. Management of the Second Stage of Labour. Methods. Selective use of episiotomy: what is the impact on perineal trauma? Psychosocial support, education, communication, choice of position, and pharmacological methods appropriately used during the first stage are all useful in relieving pain and distress in the second stage of labor. A woman should be encouraged to push when full cervical dilatation, the fetal condition, and engagement of the presenting part have been confirmed, and the woman feels an urge to bear down. Currently undergoing testing by WHO and global partners is a new low‐cost device for assisted vaginal delivery: the Odon device (www.odondevice.org). Women should not be forced or encouraged to push until they feel an urge to push. In the absence thereof, there should be a written document enabling the care provider to intervene appropriately and definition of the circumstances under which this can be done. Observe progressive descent and rotation of the presenting part. Management of delivery when malposition of the fetal head complicates the second stage of labour Nicola Tempest MRCOG,a Kate Navaratnam MRCOG,b Dharani K Hapangama MD MRCOG c,* aAcademic Clinical Fellow in Obstetrics and Gynaecology, Centre for Women’s Health Research, University of Liverpool and Liverpool Women’s Hospital NHS Foundation Trust, Crown Street, Liverpool L8 7SS, UK This stage begins when the cervix starts to soften and to open. Related QI Initiative. Cochrane Database Syst Rev 5:CD002006, 2017. doi: 10.1002/14651858.CD002006.pub4. Health system funders, designers, and managers need to develop and rollout sustainable plans for ensuring that the necessary human resources, skills, and equipment are in place in a structured manner at each level of the health system. All women require close monitoring during the second stage of labor and service planners need to recognize this in formulating shift plans. The second stage of labor is defined as the time from complete dilation to delivery of the infant. Thus, we are not moving towards cesarean delivery too early without giving the patient adequate time to progress to vaginal birth. Continuously provide information, support, and encouragement to the woman and her companion. O'Connell MP(1), Tetsis AV, Lindow SW. You do not currently have access to this tutorial. Here, birth planning needs to involve relatives, traditional birth attendants (TBAs), or nonclinical staff to assist in the role of “second birth attendant.” Such assistants need to be briefed about their role and arrangements made for them to be accessible and present for the birth. In later part of the first stage and early second stage, inhalation anesthesia by mixing an equal part of oxygen and an anesthetic agent can be used. You do not currently have access to this tutorial. Unfortunately, in many hospitals in low‐resource countries, lying supine while in labor has become the norm—a tendency exacerbated by a lack of available cushions or the use of nonflexible delivery beds where the upper part cannot be elevated—and the use of stirrups is common. NURS 235 : SESSION 4 - MANAGEMENT OF THE SECOND STAGE OF LABOUR University of Ghana Distance Education. The most common indication for cesarean section is labor arrest, accounting for 34% of all primary cesarean deliveries1. Mothers with pre‐existing cardiac disease or severe anemia may be at risk of heart failure during the second stage owing to the additional circulatory demands of active pushing. In countries where care providers other than obstetricians (especially midwives) are required to perform instrumental vaginal deliveries, adequate training and supportive legislation should be in place [16]. Special consideration is needed in delivery settings where only one skilled attendant is available, such as home births or small health centers. The care in second stage of labour path for the intrapartum care pathway. Continuous support for women during childbirth by one‐to‐one birth attendants especially when the care provider is not a member of staff (14 trials; n = 12 757; RR 0.89, 95% CI, 0.83–0.96) [12]. Oxytocin (10 IU, IV/IM) is the recommended uterotonic drug for the prevention of PPH. Midwifery provision in two districts in Indonesia: how well are rural areas served? Management of the second stage of labor often follows tradition‐based routines rather than evidence‐based practices. The most common reason for cesarean section at UWMC is failure to progress or failure of descent. Clinical interventions during the second stage of labor should not be offered or advised where labor is progressing normally and the woman and baby are well, and should only be initiated when the appropriately trained staff and equipment are in place [26]. You can access the Vaginal breech tutorial for just £48.00 inc VAT. We used observational methods to perform a microanalysis of behaviors from video-recorded data. [9], [10]. At the start of the second stage, the fetal presenting part may or may not be fully engaged (meaning that the widest diameter has passed through the pelvic brim), and the woman may or may not have the urge to push. Instrumental delivery should only be attempted by care providers who are trained and qualified to recognize the indications, and are skilled and equipped to perform the procedure safely for mother and baby [13], [15]. What are the health benefits for mothers and infants of an appropriate women‐centered package of second stage care? Regarding the management of the epidural bolus during the second stage of labour, the interviewees’ opinions were divided between favourable and unfavourable to the administration of analgesic boluses after the full cervical dilatation. OOnnsseett ooff sseeccoonndd ssttaaggee FFuullll cceerrvviiccaall ddiillaattaattiioonn ((ssuurree)) IInnvvoolluunnttaarryy BBeeaarriinngg ddoowwnn TThhee uurrggee ttoo ddeeffeeccaattee aanndd uurriinnaattee.. CCoonnttrraaccttiioonnss bbeeccoommeess mmoorree pprroolloonnggeedd.. EExxppiirraattoorryy ggrruunnttiinngg wwiitthh … Equipment in good working order and devices that simplify detection of the fetal heart should be available at the recommended frequency [8]. The second stage begins when the cervix is 10cm open or fully dilated and ends with the birth of the baby. Prolonged Second StagePerinatal Outcome In 1515 Cases Perinatal Outcome in 1515 Cases of Prolonged Second Stage of Labour in Nulliparous Women Maternal and Perinatal Outcomes Associated with a Trial of ... Introduction: We examined the perinatal outcomes in Japanese singleton Page 9/27 Implementation experience during an eighteen month intervention to improve paediatric and newborn care in Kenyan district hospitals. Intervention should be considered promptly and options evaluated and acted upon before these indicative time periods if the maternal and/or fetal condition deviates from normal; for example, in the presence of fetal bradycardia or severe maternal hypertension. SECOND STAGE OF LABOUR - RECOGNITION OF NORMAL PROGRESS AND MANAGEMENT OF DELAY This LOP is developed to guide clinical practice at the Royal Hospital for Women. 358(9283):689-95. If the conditions deviate from normal, options for immediate intervention or referral depending on the care setting should be defined clearly in protocols and guidelines to allow timely access to emergency obstetric and neonatal care. SECOND STAGE OF LABOUR - RECOGNITION OF NORMAL PROGRESS AND MANAGEMENT OF DELAY This LOP is developed to guide clinical practice at the Royal Hospital for Women. For instrumental delivery, a pudendal block may be indicated, especially for forceps delivery. Pain occurred during labor … In settings where only one skilled attendant is available, briefing of relatives, TBAs, or nonclinical staff about their roles is required. Assuring safety also requires the presence of a second person trained to assist [3]. Listen frequently (every 5 minutes) to the fetal heart in between contractions to detect bradycardia. To prevent perineal injuries. It is best for short-term pain relief in the late first and second stage of labour. Encourage active pushing once the urge to bear down is present, with encouragement to adopt any position for pushing preferred by the woman, except lying supine which risks aortocaval compression and reduced uteroplacental perfusion. Care during the third stage of labour (from the birth of the baby to the birth of the placenta and membranes) remains as an issue for debate among women and practitioners on the optimum method of management. The most widely used agent is entonox, which is a 50/50 mixture of nitrous oxide and oxygen. Midwives reported their experiences of providing different care to women with epidural analgesia when compared to women without epidural, mainly … Reviewing UWMC data, most of the NTSV cesarean sections occur either after spontaneous or induced labor, implying that most are not scheduled primary cesarean sections. Individual patient circumstances may mean that practice diverges from this LOP. Internal examination should confirm complete dilation, as well as the fetal position and station, prior to the commencement of … Author information: (1)National Maternity Hospital, Dublin, Ireland. Best practice consists of antenatal identification of women with FGM and the offer of defibulation before the onset of labor, supported by appropriate counseling. To review management strategies associated with lower risk for cesarean delivery. This review of second‐stage labor care practices discusses risk factors for perineal trauma and prolonged second stage and scrutinizes a variety of care practices including positions, styles of pushing, use of epidural analgesia, and perineal support techniques. The need for active management is far from being universally recognized. 1st Year PG Nursing 2. The presence of grade 3 female genital mutilation (FGM) with obstruction of the vaginal introitus following infibulation requires staff appropriately trained in defibulation. Community mobilization is also important in providing security and support for trained staff deployed in remote locations so that they are encouraged to remain in post and able to fulfill their role. Advanced Second Stage Skills management of 2nd stage of labour.Learning objectives Safe and skilled clinical decision making in the second stage of labour Proficiency ... positions (vacuum and forceps) Quality improvement in second stage of labour management such as the prevention of obstetric anal sphincter: Study suggests epidural does not slow second stage of labour Individual patient circumstances may mean that practice diverges from this LOP. It also allows additional reassurance and support. Finally, if complications occur, the second birth attendant is able to summon help and initiate emergency care as specified in obstetric emergency skills drills, while not detracting from continuous care provided to the mother by the skilled attendant. This includes observing progressive distension of the perineum and visibility of the presenting part, and vaginal examination especially where progress appears to be slow. Alkaloids and flavonoid glycosides from the aerial parts of Leonurus japonicus and their opposite effects on uterine smooth muscle. Health system planning requires consideration of the resources needed for acquisition and maintenance of clinical skills for conduct of deliveries. One can get the best information about the condition of the fetus, and it is easiest to hear, by auscultating immediately after a contraction. Apr 28, 2016. Toolkit. This position reduces uteroplacental blood flow, can contribute to fetal distress, and provides no mechanical advantage to enhance descent. Program managers need to undertake periodic district level skills audits to ensure ongoing compliance with such skills training in the service setting. At rural health center level the community may also have a key role in assuring provision of the second attendant to assist at the time of delivery, for example by supporting community health volunteer workers or traditional birth attendants in this role where a second trained midwife is not available.

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