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Labor Stage 2: Operative Delivery

by Veronica Gillispie, MD, FACOG
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    Now let's discuss the second stage of labor. First, let's review all of our stages of labor. Stage 1 starts with the onset of labor until 10 centimeters dilated. Stage 2 starts with 10 centimeters dilated and it ends with the delivery of the fetus. And then stage 3 starts with the delivery of the fetus and ends with the delivery of the placenta. 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. Now let's review the cardinal movements of labor. First there is engagement, that's when the head enters the pelvis. Then there's descent, that is as the fetus starts to descend into the pelvis. Then there is flexion. Because of the pelvis the fetal chin will go against the chest to have the fetal vertex enter into the pelvis. Then there is internal rotation as the head starts to turn. Then there's extension as the head goes underneath the mom's pubic symphysis. And then there is external rotation where the head will go back to the original rotation. And then expulsion, and the fetus is delivered. Now if you have a little trouble, remembering all of these maneuvers, here's another metaphor that may help you. So you may think of it like a wedding. First you get engaged. Then you descend down the aisle. Then you flex your head to pray. Then you turn towards your spouse. You lift your head back up. You kiss each other. Then you externally rotate or turn towards the congregation. And then you walk down on the aisle. And that's the expulsion. I hope that helps you remember these steps. Now for stage 2, what are parameters for normal...

    About the Lecture

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

    • Operative Delivery
    • Complications of Vacuum of Operative Deliveries

    Included Quiz Questions

    1. Arrest of the second stage of labor with fetal head at least 2 cm past the ischal spines
    2. Arrest of the first stage of labor due to fetal intolerance of labor
    3. Arrest of the second stage of labor with fetal head at least at the level of the ischal spines
    4. Arrest of the second stage of labor due to fetal malpresentation
    5. Arrest of the first stage of labor due to uteroplacental insufficiency
    1. Cephalohematoma
    2. Facial laceration
    3. Skull fracture
    4. Facial nerve injury
    5. Fetal clavicular fracture
    1. She is in arrest of labor and operative vaginal delivery should be considered.
    2. She should be encouraged to continue to push for spontaneous vaginal delivery since the fetus is tolerating labor.
    3. She is in arrest of labor and cesarean section should be the next step.
    4. She is in protracted labor and cesarean section should be the next step.
    5. Although she is progressing well in labor, she should have an operational vaginal delivery due to fetal intolerance.
    1. Fetal macrosomia
    2. Fetal intolerance of labor
    3. Arrest of the 2nd stage of labor
    4. Need to shorten or decrease maternal exertion due to pre-existing conditions such as heart failure or intracranial berry aneurysms
    5. Category 3 fetal heart tracing

    Author of lecture Labor Stage 2: Operative Delivery

     Veronica Gillispie, MD, FACOG

    Veronica Gillispie, MD, FACOG


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