Arrest of the Second Stage of Labor

Aka: Arrest of the Second Stage of Labor

II. Definitions

  1. Arrest of second stage of labor
    1. No descent or rotation after a fixed time interval or pushing
  2. Protracted second stage of labor
    1. Slow rate of dilation and descent
    2. Nulliparous women
      1. Duration >3 hours (>4 hours with Epidural Anesthesia)
      2. Less than 25% of Nulliparous women will deliver vaginally after 3 hours of second stage
    3. Multiparous women
      1. Duration >2 hours (>3 hours with Epidural Anesthesia)

III. Exam

  1. See Leopold's Maneuvers (Fetal Position)

IV. Complications: Prolonged Second Stage of Labor

  1. Maternal
    1. Chorioamnionitis
    2. Cesarean Section
    3. Perineal Laceration
    4. Postpartum Hemorrhage
  2. Fetal
    1. Neonatal Sepsis
    2. NICU Admission
    3. Shoulder Dystocia

V. Management

  1. See Active Management of Labor
  2. Occiput Posterior position (or Occipitotransverse Position)
    1. See Manual Rotation in Occipitoposterior Presentation
  3. Consider assisted Vaginal Delivery

VI. References

  1. Dresang (2015) Am Fam Physician 92(3): 202-8 [PubMed]

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