Page 248 - Critical Maternity & Newborn Health Nursing

Second stage:

1. When the membranes rupture, vaginal examination is performed to

estimate the degree of cervical dilatation, to exclude prolapse of

cord and to confirm the diagnosis

2. The patient is asked to bear down during the uterine contractions

and to relax in between until the breech appears at the vulva

3. When the perineum is maximally distended episiotomy is done, this

is followed by spontaneous delivery of the breech and trunk up to
the umbilicus

4. The fetus is covered by a warm towel to prevent premature
stimulation of respiration. A loop of the cord is drawn down to feel

pulsation and to prevent compression of the cord by the fetal head
5. When the anterior scapula appears below the symphysis pubis, the

arms are delivered. This is followed by spontaneous delivery of the

shoulders

6. The aftercoming head is delivered by one of the following

methods

a) Burns –Marshal Technique: The body of the fetus is left hanging

down from the edge of the table. The fetus is supported to avoid

sudden slipping. The weight of the fetal body applies traction until

the sub-occipital region appears below the symphysis pubis. The

fetus is the moved towards the mothers abdomen to deliver the head

in flexion. Suprapubic pressure on the fetal head by an assistant

maintains flexion and helps descent of the head

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