The patient will demonstrate keeping their environment clean, safe, and aseptic. Assess signs and symptoms.Fever, uterine tenderness, bleeding, and foul-smelling lochia are signs of endometritis. Options include regional, local, and general anesthesia. Outline three nursing assessments and interventions during each stage of labor. 1. Interventions are aimed at prevention. While we have not verified the apps ourselves yet, our users have suggested ten different NCP openers which you will find . Pudendal block, rarely used because epidural injections are typically used instead, involves injecting a local anesthetic through the vaginal wall so that the anesthetic bathes the pudendal nerve as it crosses the ischial spine. Perform a breast assessment for engorgement, mastitis, and inverted nipples as well as an assessment of the infant's ability to latch and suck. Induction of labor can be Medically indicated (eg, for preeclampsia or fetal compromise) read more ). Establish a rapport with the patient and their significant other.Entertaining any questions they may have will reduce barriers in communication, ultimately easing any fears and promoting trust and relaxation. Active management of the 3rd stage of labor reduces the risk of postpartum hemorrhage Postpartum Hemorrhage Postpartum hemorrhage is blood loss of > 1000 mL or blood loss accompanied by symptoms or signs of hypovolemia within 24 hours of birth. Pregnancy can be influenced by a variety of circumstances that a pregnant woman should be informed about. Learn more about the Merck Manuals and our commitment to, Cargill YM, MacKinnon CJ, Arsenault MY, et al, Fitzpatrick M, Behan M, O'Connell PR, et al, Towner D, Castro MA, Eby-Wilkens E, et al. Recognizing cues for timely feeding promotes a better experience for mom and baby. An inability to create or maintain an environment to promote growth and attachment of the parent and child. The local anesthetics often used for epidural injection (eg, bupivacaine) have a longer duration of action and slower onset than those used for pudendal block (eg, lidocaine). UpToDate. The position of the ears can also be helpful in determining fetal position when a large amount of caput is present and the sutures are difficult to palpate. In such cases, an abnormally adherent placenta (placenta accreta Placenta Accreta Placenta accreta is an abnormally adherent placenta, resulting in delayed delivery of the placenta. Perform a depression screening.Post-partum depression can affect up to 18% of new mothers. 2. Assess knowledge.Assess the mothers knowledge about breastfeeding as well as cultural conflicts and any myths or misunderstandings. Administer oxytocin as prescribed.Oxytocin is a natural hormone used to induce labor by causing the uterus to contract. Please read our disclaimer. Assess the mother's knowledge about breastfeeding as well as cultural conflicts and any myths or misunderstandings. 4. 2. Wash with soap and water as instructed and do not scrub. Early signs of labor vary for every patient, but the most common ones are: Labor includes the following natural processes: Depending on the circumstances, babies are delivered via vaginal delivery or cesarean section. Our website services and content are for informational purposes only. Provide a calm environment.Labor can be a long process. Women without epidurals who deliver in upright positions (kneeling, squatting, or standing) have a significantly reduced risk of assisted vaginal delivery and abnormal fetal heart rate pattern, but an increased risk of second-degree perineal laceration and an estimated blood loss of more than 500 mL.27 Flexing the hips and legs increases the pelvic inlet diameter, allowing more room for delivery. Hutchison, J., Mahdy, H., Hutchison, J. Infiltration of the perineum with an anesthetic is commonly used, although this method is not as effective as a well-administered pudendal block. Nurses have had a unique and crucial role for decades. Administer antibiotics as prescribed.The administration of antibiotics during labor is controversial as the medication may affect the baby. Some read more ). This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. These drugs pass through the placenta; thus, during the hour before delivery, such drugs should be given in small doses to avoid toxicity (eg, central nervous system [CNS] depression, bradycardia) in the neonate. See more. Patients in the postpartum period will receive education and support from these nurses as they navigate recovery from birth, bonding with their infant, and maintaining their own physical, emotional, and psychological health. Offer community resources.Young, single, or unprepared parents may require the support of community resources. The patient will verbalize signs and symptoms of infection to notify the nurse and/or provider of. 4. Induction is recommended for a term pregnancy if the membranes rupture before labor begins.4 Intrapartum antibiotic prophylaxis is indicated if the patient is positive for group B streptococcus at the 35- to 37-week screening or within five weeks of screening if performed earlier in pregnancy, or if the patient has group B streptococcus bacteriuria in the current pregnancy or had a previous infant with group B streptococcus sepsis.5 If the group B streptococcus status is unknown at the time of labor, the patient should receive prophylaxis if she is less than 37 weeks' gestation, the membranes have been ruptured for 18 hours or more, she has a low-grade fever of at least 100.4F (38C), or an intrapartum nucleic acid amplification test result is positive.5, The first stage of labor begins with regular uterine contractions and ends with complete cervical dilation (10 cm). Practices that will not improve outcomes and may result in negative outcomes include discontinuation of epidurals late in labor and routine episiotomy. NURSING CARE PLAN A. The nurse is a source of support for the mother and provides education, comfort measures, and updates about the progress of their labor, and about any possible interventions that may be needed further on. Stages of Labor. Fetal risks with vacuum extraction include scalp laceration, cephalohematoma formation, and subgaleal or intracranial hemorrhage; retinal hemorrhages and increased rates of hyperbilirubinemia have been reported. NURSING CARE PLAN - postpartum hemorrhage2 - Nursing Crib. Most of the nearly 4 million births in the United States annually are normal spontaneous vaginal deliveries. . Thacker SB, Banta HD: Benefits and risks of episiotomy: An interpretative review of the English language literature, 1860-1980. Etiology Normally, the uterus continues to contract after the delivery of the baby and placenta. The patient will show no signs of infection. The nurse can discuss and explain options for pain relief and help the mother decide what is best for them. It becomes concentrated in the fetal liver, preventing levels from becoming high in the central nervous system (CNS); high levels in the CNS may cause neonatal depression. Copyright: Attribution Non-Commercial (BY-NC) Available Formats Download as PDF, TXT or read online from Scribd Flag for inappropriate content Download now of 2 NURSING CARE PLAN ASSESSMENT DIAGNOSIS INFERENCE PLANNING INTERVENTION RATIONALE EVALUATION Independent: Some read more ). The normal quantity of blood loss for a caesarean birth is roughly 1,000 ml (or a quart). 3. Obstet Gynecol 64 (3):3436, 1984. Assess the patients level of pain using the numeric pain scale.Pain is always subjective. Parenting is one of the most complex and challenging jobs you'll face in your lifetime -- but also the most rewarding. Administer antibiotics.Broad-spectrum antibiotics should be administered until cultures or pathogens are identified. Search dates: September 4, 2014, and April 23, 2015. Provide information on parenting classes and government assistance programs to aid in the safety and health of the infant. Some read more ) tend to be more common after forceps delivery than after vacuum extraction. After delivery, the cord can be removed from the neck.32 A video of the somersault maneuver is available at https://www.youtube.com/watch?v=WaJ6sZ4nfnQ. Blood cultures can also be obtained prior to starting antibiotics. The average length of the third stage of labor is eight to nine minutes.38, The greatest risk in the third stage is postpartum hemorrhage, which was recently redefined as 1,000 mL or more of blood loss or signs and symptoms of hypovolemia.39 The median blood loss with vaginal delivery is 574 mL.40 Blood loss is often underestimated by as much as 30%, and underestimation increases with increasing blood loss.41 The risk of hemorrhage increases after 18 minutes and is six times greater after 30 minutes.38 Postpartum hemorrhage is most commonly caused by atony (70% of cases).42 Other causes include vaginal or cervical lacerations, uterine inversion, retained products of conception, and coagulopathy.42 Table 5 lists risk factors for postpartum hemorrhage.42, Active management of the third stage of labor (AMTSL), which is recommended by the World Health Organization,43 is associated with a reduction in the risk of hemorrhage, both greater than 500 mL and greater than 1,000 mL, maternal hemoglobin level of less than 9 g per dL (90 g per L) after delivery, need for maternal blood transfusion, and need for more uterotonics in labor or in the first 24 hours after delivery.44 However, AMTSL is also associated with an increase in postpartum maternal diastolic blood pressure, emesis, and use of analgesia and a decrease in neonatal birth weight.44 Although AMTSL has traditionally consisted of oxytocin (10 IU intramuscularly or 20 IU per L intravenously at 250 mL per hour) and early cord clamping, the most important component now appears to be the administration of oxytocin.43,44 Early cord clamping is no longer a component because it does not decrease postpartum hemorrhage and may be associated with neonatal harm.35,44 Delayed cord clamping may avoid interfering with early transplacental transfusion and avoid the increase in maternal blood pressure and decrease in fetal weight associated with traditional AMTSL.44 More research is needed regarding the effects of individual components of AMTSL.44, Cervical, vaginal, and perineal lacerations should be repaired if there is bleeding. English Deutsch Franais Espaol Portugus Italiano Romn Nederlands Latina Dansk Svenska Norsk Magyar Bahasa Indonesia Trke Suomi Latvian Lithuanian esk . Some read more ), but it causes greater postoperative pain, is more difficult to repair, has increased blood loss, and takes longer to heal than midline episiotomy (6 Delivery of the fetus references Many obstetric units now use a combined labor, delivery, recovery, and postpartum (LDRP) room, so that the woman, support person, and neonate remain in the same room throughout their stay. Postpartum hemorrhage is the excessive bleeding following delivery of a baby. Encourage the mother to void before delivery to reduce the discomfort. School Southwestern University, Cebu City Course Title NUR 145 Uploaded By ProfKoupreyMaster1032 Pages 3 This preview shows page 1 - 3 out of 3 pages. A care plan would not be complete if no evaluation was done to test the effectiveness of your plan. Keeping the site clean after birth will also aid in faster wound recovery. Labor and delivery nurses take care of women and their babies before, during, and after the delivery. Some units use a traditional labor room and separate delivery suite, to which the woman is transferred when delivery is imminent. It is the most common gastrointestinal emergency read more and intraventricular hemorrhage (however, slightly increased risk of needing phototherapy). Discuss the importance of adequate fluid intake - Appropriate measures will be implemented to initiate voiding. Compared with interrupted sutures, continuous repair of second-degree perineal lacerations is associated with less analgesia use, less short-term pain, and less need for suture removal.45 Compared with catgut (chromic) sutures, synthetic sutures (polyglactin 910 [Vicryl], polyglycolic acid [Dexon]) are associated with less pain, less analgesia use, and less need for resuturing. A C-section is done by an obstetrician making surgical incisions in the abdomen and uterus. Clin Exp Obstet Gynecol 14 (2):97100, 1987. Once the infant's head is delivered, the clinician can check for a nuchal cord. If anesthesia is local (pudendal block or infiltration of the perineum), forceps or a vacuum extractor is usually not needed unless complications develop; local anesthesia may not interfere with bearing down. Pudendal block is a safe, simple method for uncomplicated spontaneous vaginal deliveries if women wish to bear down and push or if labor is advanced and there is no time for epidural injection. 5. From choosing baby's name to helping a teenager choose a college, you'll make . Heat or cool application and massage can ease engorgement. Because potent and volatile inhalation drugs (eg, isoflurane) can cause marked depression in the fetus, general anesthesia is not recommended for routine delivery. A cesarean delivery was performed. 7. NCP Normal Spontaneous Delivery Disturbed Sleeping Pattern Uploaded by kaye0403 Description: Nursing care plan Normal Spontaneous Delivery Disturbed Sleeping Pattern Copyright: Attribution Non-Commercial (BY-NC) Available Formats Download as DOC, PDF, TXT or read online from Scribd Flag for inappropriate content Download now of 2 Nursing Care Plan 2. (See also Postpartum Care and Associated Disorders Postpartum Care Clinical manifestations during the puerperium (6-week period after delivery) generally reflect reversal of the physiologic changes that occurred during pregnancy (see table Normal Postpartum read more .). If the fetus is in the occipitotransverse or occipitoposterior position in the second stage, manual rotation to the occipitoanterior position decreases the likelihood of operative vaginal and cesarean delivery.26 Fetal position can be determined by identifying the sagittal suture with four suture lines by the anterior (larger) fontanelle and three by the posterior fontanelle. Supportive family members and the healthcare team can also contribute. Anxiety is normal and can begin long before labor and delivery. Her nursing career has led her through many different specialties including inpatient acute care, hospice, home health, case management, travel nursing, and telehealth, but her passion lies in educating through writing for other healthcare professionals and the general public. Nurses Pocket Guide Diagnoses, Prioritized Interventions, and Rationales (11th ed.). Diagnosis is clinical. Then if the mother and infant are recovering normally, they can begin bonding. Bedside ultrasonography is helpful when position is unclear by examination findings. Lumbar epidural injection Analgesia of a local anesthetic is the most commonly used method. (2016, June 24). An alternative to delayed clamping in premature infants is umbilical cord milking, which involves pushing blood toward the infant by grasping and squeezing (milking) the cord before it is clamped. Nothing could ever make our hearts glow than seeing and cradling our own bundle of flesh and blood for the first time. However, evidence for or against umbilical cord milking is inadequate. Utilize aseptic technique during invasive procedures.The use of aseptic technique will help in preventing and limiting the growth of bacteria, such as during IV or urinary catheter insertions. In: StatPearls [Internet]. The uterus is most commonly inverted when too much traction read more . Your nurse will examine your breasts, uterus, and bladder. If ultrasonography is performed, the due date calculated by the first ultrasound will either confirm or change the due date based on the last menstrual period (Table 1).2 If reproductive technology was used to achieve pregnancy, dating should be based on the timing of embryo transfer.2. 1. Another type of episiotomy is a mediolateral incision made from the midpoint of the fourchette at a 45 angle laterally on either side. Episiotomy - aftercare. Indications for forceps and vacuum extractor are essentially the same. Retrieved May 11, 2022, from. 1. you can't develop a nursing diagnosis for someone based on a medical diagnosis (like "vaginal delivery") any more than your primary care doc can announce to you that you have, say, leukemia as you walk in the door and before s/he has taken any history or dra. Maintain a calm demeanor, giving clear and concise explanations.During emergency deliveries, anxiety may occur due to the process not meeting their expectations. Client reports that the delivery is a tolerable and highly meaningful part of her life. Second-degree laceration repairs are best performed in a continuous manner with absorbable synthetic suture. Consider the parents intellectual and emotional level as well as any physical weaknesses. Provide education on symptoms.Nurses should educate patients at discharge on signs and symptoms of infection and when to seek prompt treatment (fever, persistent pain, changes in lochia). Instruct the patient on breathing techniques.Breathing can help distract from pain. Labor is a series of contractions that help the cervix dilate to allow the fetus to move through the birth canal and out of the vagina. LEE T. DRESANG, MD, AND NICOLE YONKE, MD, MPH. Administer analgesics if ordered.An epidural can be placed to block pain below the waist. The mothers body continues to go through changes as it returns to a prepregnancy baseline. BJPsych open, 6(1), e9. Determine challenges in the parents capabilities.Young parents with an unplanned or unwanted pregnancy may lack the skills and knowledge for parenting. A woman's estimated due date is 40 weeks from the first day of her last menstrual period. Out of the nearly 4 million births in the United States in 2013, approximately 3 million were vaginal deliveries.1 Accurate pregnancy dating is essential for anticipating complications and preparing for delivery. Assess support system.A supportive partner is an important factor in effective breastfeeding. Berens, P. (2022, January). An episiotomy is not routinely done for most normal deliveries; it is done only if the perineum does not stretch adequately and is obstructing delivery. 5. o [ pediatric abdominal pain ] 4. She earned her BSN at Western Governors University. Don't automatically initiate continuous electronic fetal heart rate monitoring during labor for women without risk factors; consider intermittent auscultation first. Please read our disclaimer. The tight nuchal cord itself may contribute to some of these outcomes, however.32 Another option for a tight nuchal cord is the somersault maneuver (carefully delivering the anterior and posterior shoulder, and then delivering the body by somersault while the head is kept next to the maternal thigh). Nursing interventions are aimed at prevention. Description: A free sample nursing care plan (ncp) for Cesarian Delivery. 2. For vaginal delivery, excessive bleeding would be more than 500ml and for cesarean delivery, more than 1000ml. Allow women to deliver in the position they prefer. Now that the care plan is already established, time to take some action and implement those interventions listed on your cheat sheet. Methods include pudendal block, perineal infiltration, and paracervical block. Monitor lab work.The white blood count will be elevated along with neutrophils and lactic acid. Use to remove results with certain terms Patient will show signs of being at ease and comfort, as evidenced by resting and breathing even and unlabored. Most women with a low transverse uterine incision are candidates for a trial of labor after cesarean delivery and should be counseled accordingly. o [ abdominal pain pediatric ] Acknowledge the patients feelings and verbalizations that may indicate guilt.Knowing how the patient feels towards the process will help gauge how they understand why interventions can sometimes be required during labor and delivery and that these choices are available because they may be medically necessary and not because they are lacking personally. Skin-to-skin contact is associated with decreased time to the first feeding, improved breastfeeding initiation and continuation, higher blood glucose level, decreased crying, and decreased hypothermia.33 After delivery, quick drying of the newborn helps prevent hypothermia and stimulates crying and breathing. 4. The cord may be wrapped around the neck one or more times. The pain is caused by muscle contractions in the uterus and immense pressure on the cervix. Pain management during labor includes complementary modalities and systemic opioids, epidural anesthesia, and pudendal block. Active management includes giving the woman a uterotonic drug such as oxytocin as soon as the fetus is delivered. Here are 45 nursing care plans (NCP) and nursing diagnoses for the different stages of labor, including care plans for labor induction, labor augmentation, and dysfunctional labor: Labor Stage IA: Latent Phase Deficient Knowledge Risk for Fluid Volume Deficit Risk For Fetal Injury Risk For Maternal Infection Risk For Ineffective Coping Retrieved May 11, 2022, from, Going home after a C-section Information. Not all deliveries have gone smoothly, so every caregiver must be capable of whipping up a diagnosis and care plan immediately to assist the mother towards a safe and meaningful delivery. Postpartum Pain Management. the nursing diagnosis you are looking for is: ineffective breastfeeding r/t knowledge deficit aeb patient's comments of infant's observed inadequate intake at breast other possible nursing diagnoses for a post-delivery mother are: Local anesthetics and opioids are commonly used. Early signs of labor vary for every patient, but the most common ones are: The third stage ends with delivery of the placenta. A woman needs to go back to her normal state. The nurse should remain calm and assertive to maintain control of the situation. Actively manage the third stage of labor with oxytocin (Pitocin). Latent labor lasting many hours is normal and is not an indication for cesarean delivery.68 Active labor with more rapid dilation may not occur until 6 cm is achieved. StatPearls Publishing LLC. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. A woman will indeed feel the fullness and completeness of her life once she bore children and the realization that they have grown inside of her because she nourished them will last for the entirety of her lifetime and inspire her every day of her life. Some read more ) and anal sphincter injuries (2 Delivery of the fetus references Many obstetric units now use a combined labor, delivery, recovery, and postpartum (LDRP) room, so that the woman, support person, and neonate remain in the same room throughout their stay. Assess if the environment is comfortable for both the mother and the baby. Encourage skin-to-skin contact immediately after delivery. Patient will demonstrate and utilize practices that will help reduce the pain, such as relaxation and breathing techniques and changes in body positioning. Tears or extensions into the rectum can usually be prevented by keeping the infants head well flexed until the occipital prominence passes under the symphysis pubis. Perform physical assessment. Independent: Assess status of the client . Perinatal Parenting Stress, Anxiety, and Depression Outcomes in First-Time Mothers and Fathers: A 3- to 6-Months Postpartum Follow-Up Study. Discuss pain relief options.The mother should be in charge of her labor plan. Episiotomy prevents excessive stretching and possible irregular tearing of the perineal tissues, including anterior tears. 3. NCP-FOR-NORMAL-DELIVERY.pdf - NCP FOR NORMAL DELIVERY. It is used mainly for 1st- or early 2nd-trimester abortion. *pain related to the intensity of uterine contractions. In low-risk deliveries, intermittent auscultation by handheld Doppler ultrasonography has advantages over continuous electronic fetal monitoring. A tight nuchal cord can be clamped twice and cut before delivery of the shoulders, although this may be associated with increased neonatal complications, including hypovolemia, anemia, shock, hypoxic-ischemic encephalopathy, cerebral palsy, and death according to case reports. NCP provided the middle layer of the . *assess the comfortability of the mother with her birthing position. Prevent and treat breastfeeding complications.If ineffective breastfeeding is related to nipple pain or engorgement, intervene accordingly. The time from delivery of the placenta to 4 hours postpartum has been called the 4th stage of labor; most complications, especially hemorrhage Postpartum Hemorrhage Postpartum hemorrhage is blood loss of > 1000 mL or blood loss accompanied by symptoms or signs of hypovolemia within 24 hours of birth. Shiono P, Klebanoff MA, Carey JC: Midline episiotomies: More harm than good? Obstet Gynecol Surv 38 (6):322338, 1983. NurseTogether.com does not provide medical advice, diagnosis, or treatment. When appropriate, keep lighting dim and noises and interruptions to a minimum to allow for rest. Puerperal sepsis is an infection in the genital tract that can occur after giving birth and spread throughout the body. Other fetal risks with forceps include facial lacerations and facial nerve palsy, corneal abrasions, external ocular trauma, skull fracture, and intracranial hemorrhage (3 Delivery of the fetus references Many obstetric units now use a combined labor, delivery, recovery, and postpartum (LDRP) room, so that the woman, support person, and neonate remain in the same room throughout their stay. Do not discontinue an epidural late in labor in an attempt to avoid assisted vaginal delivery. 7. Episioproctotomy (intentionally cutting into the rectum) is not recommended because rectovaginal fistula is a risk. NURSING CARE PLAN - Nursing Crib . Discoloration and foul odor will indicate possible infection as normal fluids should appear clear, with some specks of vernix (protective layer on babys skin) and lanugo (hair covering the babys body). https://www.stanfordchildrens.org/en/topic/default?id=labor-and-delivery-138-W1314, https://www.hopkinsmedicine.org/health/wellness-and-prevention/labor, https://www.mayoclinic.org/tests-procedures/labor-induction/about/pac-20385141, https://my.clevelandclinic.org/health/articles/9675-pregnancy-types-of-delivery, Paralytic Ileus Nursing Diagnosis & Care Plan, Rupture of the amniotic sac or water breaking. Allow the mother to decide which positions relieve pain, such as side-lying, leaning, or on all fours. Apply lanolin to nipples and do not use harsh soaps. Assess knowledge. Very ill patients or serious infections require IV antibiotics. They serve as the connection between the patient and the doctor. Postpartum Nursing Interventions: We also searched the Cochrane database, Essential Evidence Plus, the National Guideline Clearinghouse database, and the U.S. Preventive Services Task Force. The most common and preferred method is vaginally because it carries the lowest risk for complications and results in a faster recovery. Women without an epidural who deliver in upright positions have a significantly reduced risk of assisted vaginal delivery and abnormal fetal heart rate pattern, but an increased risk of second-degree perineal laceration and an estimated blood loss of more than 500 mL. The fetal head comes below the pubic symphysis and then extends. See permissionsforcopyrightquestions and/or permission requests. Acknowledge and include their support system.Keeping the significant other/s involved during the process, as well as praising them for any progress, will help establish rapport and trust, leading to a more relaxed environment during childbirth. Labor and delivery, postpartum, NICU, and obstetric nurses are skilled in caring for mothers and parents through all stages of pregnancy. All Rights Reserved. Finding out how much pain the patient is experiencing is important to drive further interventions. 2. Second stage warm perineal compresses have been associated with a reduction in third- and fourth-degree perineal lacerations.28 Studies have not shown benefit to keeping hands on vs. hands off the fetal head and maternal perineum during delivery.29 Although not well studied, shorter pushes as the head is crowning are encouraged by many clinicians in an attempt to decrease perineal lacerations. Rayce, S. B., Rasmussen, I. S., Vver, M. S., & Pontoppidan, M. (2020). It will present itself as intense cramps in multiple parts of the body, such as the abdomen, groin, and back. 2. Obstet Gynecol 121(1):122128, 2013. doi: 10.1097/AOG.0b013e3182749ac9. Effectiveness of a psycho-educational intervention for expecting parents to prevent postpartum parenting stress, depression and anxiety: a randomized controlled trial. Beyond 35 weeks' gestation, there is no benefit to bulb suctioning the nose and mouth; earlier gestational ages have not been studied.34. Assess the fetal heart sounds to make sure that there is no occlusion in the cord that could hinder fetal circulation. 3. 6. The place of birth must be prepared prior to delivery. Potential positions include on the back, side, or hands and knees; standing; or squatting. This would be a crucial time since the mother would need to deliver her baby at this stage without any troubles and with her strength intact so she could push for a normal vaginal delivery. However, exploration is uncomfortable and is not routinely recommended. Repair second-degree perineal lacerations with a continuous technique using absorbable synthetic sutures. NCP definition, a type of pneumonia caused by COVID-19 in which tiny air sacs in the lungs, blocked by the virus from transferring oxygen to the blood, fill with liquids and pus, which can lead to a collapse of the lungs and in some cases death.