Second Stage of Labor

The second stage of labor involves maternal expulsive forces during uterine contractions to aid in the descent and ultimate delivery of the fetus. Instead of continuous monitoring, the fetal heart should be auscultated and recorded every 15 minutes in normal, low-risk pregnancies, and every

PRIMIGRAVID

Normal dilation curve

PRIMIGRAVID

Normal dilation curve

Prolonged latent phase

MULTIPAROUS

tio 6

Normal dilation curve

■ Prolonged deceleration phase

■ Protracted active phase

Secondary arrest of dilation

Prolonged latent phase

22 24

26 28

12 14 Hours in labor

Figure 21-7 Composite curves of normal and abnormal labor progress. (From Scherger J, Levitt C, Acheson L: Teaching family-centered perinatal care in family medicine. Part 2. Fam Med 1992;24:369.)

10 minutes in higher-risk pregnancies. The second stage of labor averages 20 minutes for the multipara and 50 minutes for the nullipara. Although pushing for longer than 2 hours without an epidural or 3 hours with an epidural in a nul-lipara should alert the practitioner to possible cephalopel-vic disproportion, pushing can continue longer in cases of adequate fetal heart rate and continued progress in descent.

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