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The second stage of labor.

Wayne R Cohen1, Emanuel A Friedman2

  • 1Department of Obstetrics and Gynecology, The University of Arizona College of Medicine, Tucson, AZ.

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|March 10, 2024
PubMed
Summary

Assessing the second stage of labor by fetal descent patterns, not just duration, is crucial for identifying abnormalities like protracted or arrested descent. Early identification aids in appropriate clinical judgments and interventions.

Keywords:
arrest of descentcephalopelvimetryfailure of descentfetal descentfetal positionlaborprolonged second stageprotracted descent

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Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine
  • Perinatology

Background:

  • The second stage of labor, from full cervical dilation to birth, involves fetal descent and rotation.
  • Traditionally assessed by duration, progress is better evaluated by fetal station changes over time.

Purpose of the Study:

  • To highlight the importance of analyzing fetal descent patterns in the second stage of labor.
  • To identify and describe graphic abnormalities in fetal descent and their clinical implications.

Main Methods:

  • Review and analysis of clinical assessments of the second stage of labor.
  • Identification of distinct patterns of fetal descent, including normal and abnormal progress.

Main Results:

  • Three main graphic abnormalities identified: protracted descent, arrest of descent, and failure of descent.
  • These abnormalities are strongly linked to cephalopelvic disproportion but can also result from maternal obesity, infection, sedation, or fetal malpositions.
  • Effective management may involve oxytocin infusion for certain inhibitory factors, but only after assessing fetopelvic relationships.

Conclusions:

  • Evaluating fetal descent patterns is more informative than duration alone for assessing second-stage labor progress.
  • Recognizing descent abnormalities is key for timely and appropriate clinical decision-making regarding interventions.
  • Management strategies should be individualized, considering factors like fetopelvic disproportion and potential benefits of interventions like oxytocin.