CHAPTERS CONTRIBUTED

MANAGEMENT OF SECOND STAGE OF LABOR


 The second stage of labor is traditionally defines as that stage of labour from full dilatation of the cervix until the delivery of the fetus, is normally characterized by continuous descent of the fetal presenting part relative to the ischial spines. The second stage of labor is a period of increased risk for the fetus, but there are very few comprehensive evidence-based clinical practice guidelines for second stage management. Considerable controversy exists concerning management aspects of second stage of labor like second stage duration, timing and techniques of pushing, effect of epidural analgesia, fetal surveillance, role of episiotomy and instrumental vaginal delivery, etc. Earlier, an arbitrary time limit was imposed on the second stage of labor, which was 60 minutes in case of primigravidas and 30 minutes in case of multigravidas. A lot of newer studies have challenged this concept and have shown that the duration of second stage could be longer without any adverse effects on the mother or the fetus. This chapter discusses the diagnosis and management of second stage of labor and examines the evidence related to various management practices and the controversies associated with the management of second stage.

 

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