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delay 2nd stage

delay 2nd stage Posted by A 4.

Dear Paul,

I am a bit confused regarding the time frame that vaginal birth should take place.

According to the NICE intrapartum guidelines 2007 it states: 'Birth is expected ti take place within 3 hours of start of active second stage for nulliparous women and within 2 hours for parous women" does not specify regarding regional anaesthsia.

On the other hand , the RCOG vaginal operative delivery 2011 guideline states: "Nulliparous women- lack of continuing progress for 3 hours (total of active and passive second-stage labour) with regional anaesthesia or 2 hours without regional anaesthesia. Multiparous women-lack of continuing progress for 2 hours (total of active and passive second stage labour) with regional anaesthesia, or 1 hour without regional anaesthesia."

In practice I follow the RCOG guideline, but if there is an EMQ or MCQ on the exam which time frame are we expected to follow?

Thank you

Posted by PAUL A.

The two guidelines are not inconsistent. In the absence of regional analgesia, 1h passive second stage is very rarely achieved unless in those rare circumstances where the head is above the spines at full dilatation. You need to read the subsequent text of the NICE guidelines as they DO NOT suggest that you intervene after 3h active pushing in a primip. You make an assessment after 2h to ensure the woman is delivered by 3h.