SECOND STAGE OF LABOUR
V. Anantha Suprasanna Lakshmi
Rollno :220
Definition:
• Second stage is the stage of expulsion
and extends from the complete
dilatation of cervix to the expulsion of
the fetus or fetuses.
• This stage may last from 1 to 2 hrs in a
primigravida and from half and hour in
multipara women.
• Second stage of labour is divided ino the pelvic phase and the
perineal phase .
1. In pelvic phase , the fetal head reaches the pelvic floor, and
the maximum fetal descent occurs .
2. In the perineal phase , bearing down contractions occur and
the head reaches the perineum.
• Unterine contractions get stronger in the second stage occuring
every 2- 3 minutes and lasting from 60-90 seconds. They are
more severe than first stage and are of ‘ bearing down’
character.
• With pushing, the intra uterine pressure may rise to 100-
150mmHg.
• With each of these contractions , the fetus is pushed further
down through the dilated cervical canal , and the vagina relaxes
and dilates to reeive it.
• When fetal head reaches the perineum it stretches so that it
begins to bulge with each uterine contraction.
• Finally, the head passes through the outlet , with a series of
almost continuous uterine contractions,helped by the straining
efforts due to the action of accessory muscles of labour,
• As the expulsion of the head takes place , the woman exerts one
last effort, delivery ering the rest of the fetus.
MECHANISM OF LABOUR
Mechanism of labour is
defined as the process by which
the fetus adjusts itself to the pelvic
architecture and maneouvres itself
through the parturient canal with
minimal difficulty to achieve a safe
vaginal delivery.
Cardinal movements of the
fetus:
1. Engagement:
It denotes that the greatest transverse diameter of the
fetal head ( biparietal diameter ) has passed through the pelvic
inlet.
In all cephalic presentations, the greatest transverse diameter is
always the biparietal diameter , which is 9.4 cm.
In a primigravida, engagement usually occurs during during last
few weeks of pregnancy i.e., at or after 38 weeks , whereas in
multigravida , it usually occurs at the onset of labour.
Types of engagement
Synclitic engagement Asynclitic engagement
Anterior Posterior
asynclitism asynclitism
2. Descent:
• Descent is the continuous downward movement of the fetus
through the birth canal and it is brought about by 4 important
factors:
1. Direct downward pressure of the fundus of the uterus on
the breech during utrine contractions.
2. Hydrostatic pressure of amniotic fluid.
3. Extension and straightening of the fetal body.
4. Abdominal muscles contractions during bearing down in the
second stage of labour.
By abdominal palpation, the descent of the head is
assessed and described as the number of the fifths of the
fetal head palpable per abdomen above symphysis pubis.
By vaginal examination, the descent of the head is
assessed by the level of the occiput in relation to the
ischial spines.
3.Flexion:
• As the head descends, the fetal neck is
flexed, and the chin touches the chest.
• Flexion is caused by the shape of the
uterus and the resistance of the pelvic
floor and the pressure exerted by the
uterine wall and cervix.
• It allows the smallest diameter of the
fetal head to descend into the pelvis.
4.Internal rotation
• During internal rotation, the head moves from the
occipitotransverse or oblique position to occipitoanterior
position with the occiput moving anteriorly towards the pubic
symphysis .
• The movement of internal rotation is caused by levator ani
muscles . The tonic resistance of this muscle rotates the vertex
anteriorly.
• In the transverse position, occiput has to rotate through 90° ,
while in anterior positions, the occiput rotates through 45° so
that the occiput is under the pubic symphysis.
5. Extension and birth of fetal
head
• During the process of extension the largest diameter of the fetal
head is encircled by the vulvar ring this is called crowning.
• At this stage the perineum is streched.
• The vulvar outlet is directed upward and forward . Therefore the
extension of head must occur before the head can pass through.
• Extension is result of two forces –
1. Effect of uterine contractions from above .
2. Elastic resistance of pelvic floor from below.
6.Restitution
• At the time of internal rotation, the head gets twisted on the
shoulder by 45°. It subsequently gets untwisted once the
head is delivered. This is called Restitution.
• This movement results on the occiput turning to the mother’s
left thigh in the LOA position.
• The fetal body then rotates to bring one shoulder behind the
symphysis pubis.
7. External rotation:
• After the neck has untwisted, the next movement is the
internal rotation of the shoulders, which brings the
bisacromial diameter into anteroposterior diameter .
• Head rotates another 45° in order to maintain its alignment
with shoulder.
• With the external rotation of the head to the transverse
position , the occiput lies next to left maternal thigh.
8. Expulsion :
• Once the shoulders have roated , the descent continues until
the anterior shoulder hitches under the pubic symphysis and
posterior shoulder sweeps over the perineum bya process of
lateral flexion of the spine and is delivered first.
• This is followed by a slight slipping forward of the anterior
shoulder from underneath the pubis symphysis.
• After the expulsion of shoulders, fetal body slips down
through the pelvic cavity.
