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Labor Stage 2: Normal and Abnormal Labor

by Veronica Gillispie, MD, FACOG
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    00:01 Now let's discuss the second stage of labor.

    00:06 First, let's review all of our stages of labor.

    00:09 Stage 1 starts with the onset of labor until 10 centimeters dilated.

    00:14 Stage 2 starts with 10 centimeters dilated and it ends with the delivery of the fetus.

    00:19 And then stage 3 starts with the delivery of the fetus and ends with the delivery of the placenta.

    00:26 So it's important to know that during stage 2, the fetus is entering the pelvis through the cardinal movements of labor which begin in stage 1 and are completed in stage 2.

    00:38 Now let's review the cardinal movements of labor.

    00:41 First there is engagement, that's when the head enters the pelvis.

    00:45 Then there's descent, that is as the fetus starts to descend into the pelvis.

    00:50 Then there is flexion.

    00:52 Because of the pelvis the fetal chin will go against the chest to have the fetal vertex enter into the pelvis.

    00:58 Then there is internal rotation as the head starts to turn.

    01:04 Then there's extension as the head goes underneath the mom's pubic symphysis.

    01:08 And then there is external rotation where the head will go back to the original rotation.

    01:13 And then expulsion, and the fetus is delivered.

    01:16 Now if you have a little trouble, remembering all of these maneuvers, here's another metaphor that may help you.

    01:22 So you may think of it like a wedding.

    01:25 First you get engaged.

    01:27 Then you descend down the aisle.

    01:29 Then you flex your head to pray.

    01:31 Then you turn towards your spouse.

    01:33 You lift your head back up.

    01:35 You kiss each other.

    01:37 Then you externally rotate or turn towards the congregation.

    01:41 And then you walk down on the aisle.

    01:43 And that's the expulsion.

    01:44 I hope that helps you remember these steps.

    01:48 Now for stage 2, what are parameters for normal labor? In our primiparous patient with an epidural, we expect that baby to be pushed out within 3 hours.

    01:58 For multiparous mom 2 hours.

    02:01 Without an epidural for primiparous mom, the baby should be pushed within 2 hours.

    02:06 And for our multiparous mom without an epidural, we expect the baby to come out within 1 hour.

    02:12 A stage 2 progresses but takes longer than the expected parameters we have listed here.

    02:18 This is considered a protracted second stage.

    02:20 If there is no descent for more than 2 hours, this is considered an arrest of the second stage of labor.

    02:27 So abnormal labor in the second stage is considered an arrest.

    02:34 When that occurs, an operative delivery must happen.

    02:37 If the fetus is less than +2 station, meaning the head is higher than +2 station then you would proceed with a cesarean delivery.

    02:46 If the head is below +2 station and all the other parameters are met an operative vaginal delivery can happen.

    02:54 That's discussed in another lecture.


    About the Lecture

    The lecture Labor Stage 2: Normal and Abnormal Labor by Veronica Gillispie, MD, FACOG is from the course Intrapartum Care. It contains the following chapters:

    • Second Stage of Labor
    • Stage 2 – Normal Labor
    • Stage 2 – Abnormal

    Included Quiz Questions

    1. Arrest of labor due to fetal malpresentation or fetal-pelvic disproportion; cesarean section should be the next step.
    2. Arrest of labor due to fetal malpresentation or fetal-pelvic disproportion; operative vaginal delivery should be the next step.
    3. Protracted second stage of labor due to fetal malpresentation; allow for another 1 hour of passive decent and rest to avoid maternal exhaustion.
    4. Protracted second stage of labor due to pelvic disproportion; operative vaginal delivery should be the next step.
    5. Normal progression of second stage of labor; continue expectant management and coaching pushing with mom.
    1. 2 hours
    2. 1 hour
    3. 3 hours
    4. 4 hours
    5. 6 hours
    1. 2 hours
    2. 3 hours
    3. 1 hour
    4. 4 hours
    5. 6 hours
    1. Extension of the head
    2. Flexion of the chin
    3. External rotation
    4. Internal rotation
    5. Expulsion

    Author of lecture Labor Stage 2: Normal and Abnormal Labor

     Veronica Gillispie, MD, FACOG

    Veronica Gillispie, MD, FACOG


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