Obstetrics and gynecology. Management of the second stage of labor (most important)

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Obstetrics and gynecology. Management of the second stage of labor (most important)

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15. Management of the second stage of labor

Prepare to the adoption of childbirth begins from the moment of insertion of the fetal head in primiparas, and in multiparous - from the moment of full disclosure of the cervix. The woman in labor is transferred to the delivery room, where the equipment, instruments, sterile material and linen for the primary toilet of the newborn should be ready.

Position of the woman in labor. To prevent compression of the aorta and inferior vena cava by the uterus, the pregnant woman is placed in the gynecological position with a slight tilt to the left side. This provides good access to the perineum. The most comfortable position during childbirth is the semi-sitting position (it does not affect the condition of the fetus and reduces the need to use obstetric forceps). To perform a half-sitting birth, leg holders are attached to the table.

The perineum is treated with iodine. Choose a method of anesthesia.

Surveillance for spontaneous childbirth includes:

1) monitoring the condition of the woman in labor (pulse, blood pressure, temperature);

2) control over the nature of contractile activity and the condition of the fetus (external and internal CTG);

3) keeping a partogram;

4) determination of CBS from the presenting part of the fetus (according to indications);

5) the introduction of antispasmodic and painkillers;

6) epidno- and perinatomy (according to indications);

7) provision of manual assistance at the birth of a child;

8) prevention of bleeding during childbirth (according to indications);

9) assessment of the child's condition at birth according to the Angar scale and, if necessary, assistance to him.

Obstetric benefit for anterior occipital presentation

Removing the head. The obstetric aid is aimed at preventing premature extension of the head and at carefully removing the fetal face and chin by pressing on the perineum and pushing it back and down. After the birth of the head, mucus is removed from the fetal nasopharynx and oropharynx by suction using a catheter. If the umbilical cord is entwined around the neck, they try to move the umbilical cord to the back of the head or torso.

Removing the hanger. To birth the anterior shoulder, the fetal head is slightly deflected down; when the anterior shoulder emerges from under the pubic arch, the head is lifted upward and the posterior shoulder is carefully brought out. When cutting through the shoulders, a significant stretch of the soft tissue occurs, and the perineum can rupture, so special attention should be paid to this process.

The final stage. After birth, the baby’s shoulders are removed and turned onto his stomach to free the nasopharynx from mucus; after removing the mucus, two clamps are applied to the umbilical cord and it is crossed so that the remainder of the umbilical cord is 2-3 cm. The umbilical ring is examined to exclude an umbilical hernia and hernia of the umbilical cord. . To establish first contact, the baby is briefly placed on the mother's stomach and then placed in the incubator.

Author: Ivanov A.I.

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