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The Second Stage of Labour: Durational Dilemmas
Author(s) -
Deiham Roger J.,
Crowhurst John,
Crowther Caroline
Publication year - 1991
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.1991.tb02760.x
Subject(s) - caesarean section , fetal distress , stage (stratigraphy) , distress , medicine , forceps delivery , episiotomy , duration (music) , obstetrics , pregnancy , vaginal delivery , fetus , paleontology , clinical psychology , art , genetics , literature , biology
EDITORIAL COMMENT: We commend this essay on the second stage of labour to all readers since it will encourage them to rethink their management of the patient who is in the second stage of labour, without evidence of fetal or maternal distress. The editorial committee firmly agrees with the authors'belief that midforceps delivery is a dangerous manoeuvre and should be performed only when indicated, rather than because the patient is deliverable or because the second stage has exceeded a statutory period of 1–2 hours. We were taught many years ago, when difficult manipulative deliveries were more often resorted to, and when the Caesarean section rate was less than half of the present rate land the perinatal mortality rate was more than double the present rate J that ‘distress plus dystocia is dangerous for the fetus’ and we consider that this adage remains true. The permissible duration of the second stage of labour, when the head is on view, and where delivery can be readily effected by episiotomy, with or without low forceps delivery, is another mailer. In this instance the obstetric philosophy of the accoucheur will determine whether to act or to wait. (A) Cacsaican section rate6.2%: perinatal mortality rale 3 5%, Medical and Clinical Report, Royal Women's Hospital. Melbourne, 1970. Summary: The optimal management of prolonged second stage of labour remains a confused area of thought and action. This confusion is particularly evident when epidural analgesia is also being used. A review of the literature indicates that prolonged duration of the second stage, i.e. from full dilation of the cervix until delivery, with or without epidural analgesia, has little adverse effect on perinatal outcome. More attention should be paid to the expulsive phase of the second stage and greater efforts made to reduce unnecessary interventions.