The second stage of labor is defined as the interval between the complete dilation of the cervix to the delivery of the infant. As with previous stages of labor, abnormalities in
this stage include a protracted rate or a complete "arrest of descent," or the more common term failure of descent, used to describe an unchanged station. The evaluation of descent disorders should include maternal and fetal well-being, adequacy of contractions, obstructive etiologies (e.g., distended bladder), and cephalopelvic relationships. Other mitigating factors include maternal exhaustion, ineffective pushing, conduction anesthesia, and perineal resistance. There is also a high incidence of CPD with this condition and an increased risk of operative deliveries.
A protracted descent is more difficult to gauge but is defined by a rate of less than 1 cm/hr in nullipara women and less than 2 cm/hr in multiparous women. This diagnosis should prompt an evaluation for such causes as CPD, macrosomia, and inadequate pushing.
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