Second Stage of Labor

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What happens in the Second Stage of Labor?

The second stage of labor begins with complete cervical dilation and ends with delivery of the fetus. Epidural, spinal, or pudendal nerve blocks (S2-S4) are used if necessary to relieve pain.


• 2 hours in primipara.

• 1 hour in multipara.

Management of Normal Spontaneous Labor:

• Episiotomy is performed if necessary.

• IV oxytocin is administered to prevent uterine atony and bleeding.

Prolonged Second Stage:

• Pregnant with regular uterine contractions.

• 10 cm dilation at +1 station.

• No descent change in 3 hours.

Management of Prolonged Second Stage:

• If contractions are hypotonic, administer oxytocin.

• If fetal head engaged, use obstetric forceps or vacuum extractor delivery.

• If fetal head not engaged, do emergency C-section.

Additional Reading:

Notes on Stages of Labor:

1. Diagram of Stages of Labor
2. First Stage of Labor
3. Second Stage of Labor
4. Third Stage of Labor
5. Fourth Stage of Labor

Tests for Fetal Well-Being:

1. Notes on Non-Stress Test
2. Notes on Contraction Stress Test
3. Unresponsive Fetus Algorithm

Periodic Changes in Fetal Heart Rate:

1. Fetal Heart Rate Accelerations
2. Variable Decelerations of Fetal Heart Rate
3. Early Decelerations of Fetal Heart Rate
4. Late Decelerations of Fetal Heart Rate

Types of Spontaneous Abortion:

1. Notes on Complete Abortion
2. Notes on Incomplete Abortion
3. Notes on Threatened Abortion
4. Notes on Inevitable Abortion
5. Notes on Missed Abortion

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