Normal Labor (Pt2)

Question 2

Managment of Labor

• 1st Stage

Answer 2

Question 3

Management of 2nd stage of Labor

Answer 3

• Before Head Delivery
• Head Delivery
• After Head Delivery

Question 4

Management of 2nd stage of Labor

• Before Head Delivery

Question 5

Management of 2nd stage of Labor

• position

Answer 5

Lithotomy position on delivery table.

Question 6

Management of 2nd stage of Labor

• Sterialization & Towelling

Answer 6

…

Question 7

Management of 2nd stage of Labor

• Evacuation

Answer 7

Evacuation of bladder & rectum.

Question 8

Management of 2nd stage of Labor

• Bearing Down?

Answer 8

Ask patient to bear down during uterine contractions only & relaxes () contractions.

Question 9

Management of 2nd stage of Labor

• Observation

Answer 9

Observations for maternal & fetal conditions.

Question 10

Management of 2nd stage of Labor

• Head Delivery

Answer 10

Question 11

Aim in Head delivery

Answer 11

Decrease Perineal Lacerations

Question 12

Head delivery

• When to support Perineum?

Answer 12

As soon as head distends vulva, attendant supports perineum by closed fist of hand & pad of cotton

Question 13

Head delivery

• Why Support The Perineum?

Answer 13

to maintain flexion of head till crowning occurs (to ensure distension of vulva by the smallest diameter of fetal head).

Question 14

Head delivery

• Managment of Head Extension

Answer 14

• If extension occurred before crowning (premature extension) → Increased diameter distending vulva → perineal tear.
• After crowning, head is allowed to extend in () uterine contractions (not during uterine contractions) by Ritgen ‘s maneuver which means upward & backward pressure on perineum & downward pressure on occiput to allow gradual extension of head.

Question 15

Head delivery

• After Crowning

Answer 15

• After crowning, head is allowed to extend in () uterine contractions (not during uterine contractions) by Ritgen ‘s maneuver
• Which means upward & backward pressure on perineum & downward pressure on occiput to allow gradual extension of head.

Question 16

Head delivery

• Episiotomy

Answer 16

Episiotomy is done è crowning when it is indicated.

Question 17

Management of 2nd stage of Labor

• After Delivery of Head

Question 18

Management of 2nd stage of Labor

• Swabbing

Answer 18

Baby’s eyelids, mouth & nose are swabbed.

Question 19

Management of 2nd stage of Labor

• Suction

Answer 19

Suction is done to clear airway starting by mouth then nose.

Question 20

Management of 2nd stage of Labor

• Examination of Cord

Answer 20

• Examination for any loop of cord coiled around neck: If coils of cord are present, do either slipping of coil or division of cord if tight) in () 2 clamps.

Question 21

Management of 2nd stage of Labor

• Delivery of Shoulders

Answer 21

Question 22

Management of 2nd stage of Labor

• Delivery of Trunk & rest

Answer 22

Easily

Question 23

Management of 2nd stage of Labor

• Holding Newborn

Answer 23

• Newborn is held from his feet è head down for few seconds to drain respiratory passage

Question 24

Management of 2nd stage of Labor

• When to avoid Holding Newborns in upside down way?

Answer 24

Except in cases of

• Prematurity
• Asphyxia
• Possibility for ICH

Question 25

Management of 2nd stage of Labor - Ligation & Cutting of Cord

Answer 25

Question 26

Management of 2nd stage of Labor - When to avoid milking Cord?

Answer 26

Cord is clamped immediately eout milking in the following conditions: - Premature baby: To avoid hypervolemia, HF & hyperbilirubinemia. - Rh isoimmunization: To Decrease Abs reaching neonate. - Diabetic mother: To avoid hypervolemia. - Multifetal pregnancy. - After general anesthesia: To anesthetic agents & get early recovery.

Question 27

Management of 2nd stage of Labor - Inspection of Lower Genital Tract & Perineum

Answer 27

For lacerations & tears.

Question 28

Managment of 3rd stage of Labor

Question 29

Managment of 3rd stage of Labor - Aims

Answer 29

1) Ensuring complete expulsion of placenta & membranes. 2) Prevention of PPH.

Question 30

Managment of 3rd stage of Labor - Methods

Answer 30

- Conservative - Active

Question 31

**Expectant** Managment of 3rd stage of Labor - Method

Answer 31

Question 32

**Expectant** Managment of 3rd stage of Labor - Advantages

Answer 32

Safe

Question 33

**Expectant** Managment of 3rd stage of Labor - Disadvantages

Answer 33

Time consuming & more blood loss.

Question 34

**Active** Managment of 3rd stage of Labor - Method

Answer 34

Question 35

**Active** Managment of 3rd stage of Labor - Advantages

Answer 35

Decrease duration of 3rd stage ----> Decrease blood loss -----> decrease incidence of PPH.

Question 36

**Active** Managment of 3rd stage of Labor - Disadvantages

Answer 36