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Arrest of the Second Stage of Labor

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1. Arrest of the Second Stage of Labor

Arrest of the Second Stage of Labor Arrest of the Second Stage of Labor Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Arrest (...) of the Second Stage of Labor Arrest of the Second Stage of Labor Aka: Arrest of the Second Stage of Labor From Related Chapters II. Definition Arrest of the Second Stage of Labor No descent or rotation after a fixed time interval or pushing Multiparous No epidural: 2 hours Epidural: 3 hours Nulliparous No epidural: 3 hours Epidural: 4 hours III. Exam See ( ) IV. Complications: Prolonged second stage of labor V. Management position (or Occipitotransverse Position) See Consider assisted VI. References Images

2018 FP Notebook

2. The impact of extending the second stage of labor to prevent primary cesarean section on maternal and neonatal outcomes. (PubMed)

with regional anesthesia or 2 hours if no such anesthesia was provided. Second-stage arrest was defined in multiparous women after 2 hours with regional anesthesia or 1 hour without it. Period II (10,531 patients): from May 2014 until April 2017, allowed nulliparous and multiparous women continuing the second stage of labor an additional 1 hour before diagnosing second-stage arrest. Singleton deliveries at or beyond 37 weeks' gestation were initially considered for eligibility. We excluded women with high (...) The impact of extending the second stage of labor to prevent primary cesarean section on maternal and neonatal outcomes. A low rate of primary cesarean delivery is expected to reduce some of the major complications that are associated with a repeat cesarean delivery, such as uterine rupture, adhesive placental disorders, hysterectomy, and even maternal death. Since 2014, and in alignment with the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine, we

2018 American Journal of Obstetrics and Gynecology

3. First Stage of Labor Progression in Women with Large-for-Gestational Age Infants. (PubMed)

First Stage of Labor Progression in Women with Large-for-Gestational Age Infants. Women with suspected large-for-gestational age (LGA) fetuses have higher rates of dysfunctional labor and labor arrest diagnoses, and consequently higher rates of cesarean deliveries. Identifying factors that significantly affect labor progression of women with LGA infants may better inform expected duration of labor for certain subgroups of this population.As standards for the first stage of labor when LGA (...) progressed slower in nulliparous compared to multiparous women (3.28 hours [0.71-15.16] vs. 2.03 hours [0.44-9.39]; p<0.01), and in obese compared to non-obese women (2.36 hours [0.51-10.91] vs. 1.79 hours [0.39-8.31]); p<0.01). Labor curves did not differ between LGA and AGA groups when stratified by labor onset (non-augmented spontaneous labor vs. induced labor) or the presence of DM/GDM.After 3cm cervical dilation, the time required to reach the second stage of labor is greater in women with LGA

2019 American Journal of Obstetrics and Gynecology

4. Success of trial of labor in women with a history of previous cesarean section for failed labor induction or labor dystocia: a retrospective cohort study. (PubMed)

% in women with a history of labor arrest in the second stage of labor, and 59.0% in women with previous failed induction. The adjusted risk factors for recurrent failed induction or labor dystocia were maternal height < 160 cm (OR 1.9 95% CI 1.1-3.1), no prior vaginal delivery (OR 8.3 95% CI 3.5-19.8), type 1 or gestational diabetes (OR 1.8 95% CI 1.0-3.0), IOL for suspected non-diabetic fetal macrosomia (OR 10.8 95% CI 2.1-55.9) and birthweight ≥4500 g (OR 3.3 95% CI 1.3-7.9).TOLAC is a feasible option (...) cohort study of 660 women with a prior CS for failed labor induction or labor dystocia undergoing TOLAC was carried out in Helsinki University Hospital, Finland, between 2013 and 2015. Data on the study population was obtained from the hospital database and analyzed using SPSS.The rate of vaginal delivery was 72.9% and the rate of repeat CS for failed induction or labor dystocia was 17.7%. The rate of successful TOLAC was 75.6% in women with a history of labor arrest in the first stage of labor, 73.1

Full Text available with Trip Pro

2019 BMC Pregnancy and Childbirth

5. Approaches to Limit Intervention During Labor and Birth

or obstetric complications. c When not coached to breathe in a specific way, women push with an open glottis. In consideration of the limited data regarding superiority of sponta- neous versus Valsalva pushing, each woman should be encouraged to use her preferred and most effec- tive technique. c Collectively, and particularly in light of recent high- quality study findings, data support pushing at the start of the second stage of labor for nulliparous women receiving neuraxial analgesia. Delayed pushing (...) difference that exceeded the effect of amniotomy with oxytocin (mean difference, 21.11 hours). Women in upright positions also were less likely to have a cesarean delivery (RR, 0.71; 95% CI, 0.54–0.94) (43). A second Cochrane meta-analysis of RCTs that examined the effect of position during the second stage of labor found that upright or lateral positions compared with supine positions are associated with fewer “abnormal” fetal heartratepatterns(RR,0.46;95%CI,0.22–0.93),areduc- tion in episiotomies (RR

2019 American College of Obstetricians and Gynecologists

6. Routine Maternal Leg Movements During the Second Stage and the Rate of Operative Deliveries

indication for cesarean delivery, Maternal position during the second stage of labor has been suggested to affect the risk of instrumental vaginal delivery. A Cochrane review of position in the second stage of labor in women without epidural showed a reduction in instrumental vaginal delivery in the upright group, although the quality of the included trials was reported to be generally poor, A Cochrane review of position in the second stage of labour for women with epidural analgesia was published (...) in 2017, This review included trials that compared upright with recumbent positions and suggested no effect. No prior studies examined whether maternal legs movement during the second stage of labor has any effect on the rate of operative deliveries. Condition or disease Intervention/treatment Phase Cesarean Delivery Affecting Fetus or Newborn Other: Routine leg movement Not Applicable Detailed Description: A randomized controlled trial to determine whether routine maternal leg movement during

2018 Clinical Trials

7. Labor induction abortion in the second trimester

Labor induction abortion in the second trimester Clinical Guidelines Labor induction abortion in the second trimester Release date February 2011 SFP Guideline 20111 Abstract Labor induction abortion is effective throughout the second trimester. Patterns of use and gestational age limits vary by locality. Earlier gestations (typically 12 to 20 weeks) have shorter abortion times than later gestational ages, but differences in complication rates within the second trimester according to gestational (...) to abortion. While isolated case reports and retrospective reviews document uterine rupture during second-trimester induction with misoprostol, the magnitude of the risk is not known. The relationship of individual uterotonic agents to uterine rupture is not clear. Based on existing evidence, the Society of Family Planning recommends that, when labor induction abortion is performed in the second trimester, combined use of mifepristone and misoprostol is the ideal regimen to effect abortion quickly

2011 Society of Family Planning

8. Arrest of the Second Stage of Labor

Arrest of the Second Stage of Labor Arrest of the Second Stage of Labor Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Arrest (...) of the Second Stage of Labor Arrest of the Second Stage of Labor Aka: Arrest of the Second Stage of Labor From Related Chapters II. Definition Arrest of the Second Stage of Labor No descent or rotation after a fixed time interval or pushing Multiparous No epidural: 2 hours Epidural: 3 hours Nulliparous No epidural: 3 hours Epidural: 4 hours III. Exam See ( ) IV. Complications: Prolonged second stage of labor V. Management position (or Occipitotransverse Position) See Consider assisted VI. References Images

2015 FP Notebook

9. CRACKCast E180 – Labor & Delivery

of cord prolapse are unexpected and develop during the second stage of labor. Risk factors: We’ll just list the Fetal and Maternal causes (from Uptodate) Malpresentation (breech, transverse, oblique, or unstable lie) Prematurity Low birth weight Second twin Low lying placentation Pelvic deformities Uterine malformations/tumors External fetal anomalies Multiparity Polyhydramnios Long umbilical cord Unengaged presenting part Prolonged labor Cord prolapse has a variable rate of association with different (...) ● Progression ● Bloody show / mucus ● Plug expelled ● Cervical dilation and/or effacement (first stage of labour) When in doubt, ask for obstetric assessment; wait and see; and get fetal/electrical monitoring! 2) Describe the 4 phases of labor Phase 1 Phase 2 Phase 3 Phase 4 Latent phase Active phase (cervix >3cm) ● Where we determine what the presenting part is Fully dilated cervix Urge to push Usually lasts < 1 hr Get ready for delivery! Signs of placental separation include the following: the uterus

2018 CandiEM

10. Trial of IV NTG for CD After Second Stage Arrest for the Prevention of Uterine Extension

of California, San Francisco Information provided by (Responsible Party): University of California, San Francisco Study Details Study Description Go to Brief Summary: Randomized controlled clinical trial of IV nitroglycerin at cesarean delivery for second stage arrest of descent to prevent or uterine extension at the hysterectomy site. Condition or disease Intervention/treatment Phase Prolonged Second Stage of Labor Drug: intravenous nitroglycerin Phase 4 Detailed Description: Intravenous nitroglycerin (...) resulting in uterine relaxation has been standardly utilized for various obstetrics conditions, e.g. breech extraction of second twin in vaginal deliveries, uterine relaxation after tachysystole in labor, prior to external cephalic version, and during difficult fetal extraction during cesarean delivery for arrest of descent in labor. Currently the use of nitroglycerin is at equipoise in obstetrics for difficult cesarean delivery after second stage arrest in labor. The clinical trial will randomize women

2014 Clinical Trials

11. Approaches to Limit Intervention During Labor and Birth

data regarding superiority of spontaneous versus Valsalva pushing, each woman should be encouraged to use her preferred and most effective technique. Collectively, and particularly in light of recent high-quality study findings, data support pushing at the start of the second stage of labor for nulliparous women receiving neuraxial analgesia. Delayed pushing has not been shown to significantly improve the likelihood of vaginal birth and risks of delayed pushing, including infection, hemorrhage (...) , with recumbent, lateral, or supine positions during the first stage of labor found that upright positions shorten the duration of the first stage of labor by approximately 1 hour and 22 minutes (mean difference, –1.36; 95% CI, –2.22 to –0.51), a mean difference that exceeded the effect of amniotomy with oxytocin (mean difference, –1.11 hours). Women in upright positions also were less likely to have a cesarean delivery (RR, 0.71; 95% CI, 0.54–0.94) (43). A second Cochrane meta-analysis of RCTs that examined

2017 American College of Obstetricians and Gynecologists

12. Descent of the Fetal Head (Station) During the First Stage of Labor. (PubMed)

Descent of the Fetal Head (Station) During the First Stage of Labor. High station at specific points in the first stage of labor, such as a floating head on admission, or at 4-cm dilation or when arrest of dilation occurs, is associated with higher rates of failure to deliver vaginally. Therefore it could be useful to know if station is within an expected range at a given dilation during first stage. Arrest of descent disorders have been defined thus far on criteria applicable in the second (...) between station and dilation in the first stage of uncomplicated births and then determine if such a model would have identified births with complications related to poor labor progress. Given the complex nature of labor data, especially the imprecision of dilation and station measurement, it is not immediately evident that such a model is identifiable or what its precision would be.We sought to characterize in mathematical terms the relationship of station to dilation during the first stage of labor

2015 American Journal of Obstetrics and Gynecology

13. Cardiac Arrest in Pregnancy

as an alternative to the first or second dose of epinephrine ( Class IIb; Level of Evidence A ). A new concept under investigation is the use of a combination of drugs during vasopressor-requiring cardiac arrest. A randomized study of patients with in-hospital cardiac arrest demonstrated that the combination of vasopressin-epinephrine and methylprednisolone during CPR and stress-dose hydrocortisone in postresuscitation shock led to improved survival to hospital discharge compared with epinephrine alone. Despite (...) Cardiac Arrest in Pregnancy Cardiac Arrest in Pregnancy | Circulation Search Hello Guest! Login to your account Email Password Keep me logged in Search October 2019 September 2019 August 2019 July 2019 June 2019 May 2019 April 2019 March 2019 February 2019 January 2019 This site uses cookies. By continuing to browse this site you are agreeing to our use of cookies. Free Access article Share on Jump to Free Access article Cardiac Arrest in Pregnancy A Scientific Statement From the American Heart

2015 American Heart Association

14. New Labor Management Guidelines and Changes in Cesarean Delivery Patterns. (PubMed)

, rates of arrest of dilation disorders have decreased, leading to a decrease in the rate of cesarean delivery; (2) in the second stage, pushing duration prior to diagnosis of arrest of descent has increased, also leading to a reduction in the rate of cesarean delivery for this indication. As a secondary aim, we investigated changes in maternal and neonatal morbidity.This was a secondary analysis of a prospective cohort study of all patients presenting at ≥37 weeks' gestation from 2010 through 2014 (...) with a nonanomalous vertex singleton and no prior history of cesarean delivery. Rates of cesarean delivery, arrest of dilation, and changes in rates of maternal and neonatal morbidity were calculated in crude and adjusted models. Cervical dilation at diagnosis of the arrest of dilation, time spent at the maximal dilation prior to diagnosis of arrest of dilation, and time in the second stage prior to the diagnosis of arrest of descent were compared over the study period.There were 7845 eligible patients

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2017 American Journal of Obstetrics and Gynecology

15. Impact of recommended changes in labor management for prevention of the primary cesarean delivery. (PubMed)

with amniotomy and epidural anesthesia to no change after 4 hours of adequate or 6 hours of inadequate contractions in women with an epidural. The definition of second-stage arrest of labor changed simultaneously from lack of progress for 3 hours with adequate contractions in women with epidural anesthesia to no progress for ≥4 hours in nulliparas or 3 hours in multiparas with an epidural. We compared maternal and neonatal outcomes over two 1 year periods: from March 2013 to February 2014 (before (...) delivery rate decreased significantly from 9.4% in the preguideline to 6.9% in the postguideline period (odds ratio, 0.71; 95% confidence interval, 0.59-0.85; P < .01). The cesarean delivery rate for arrest of first-stage labor fell by half, from 1.8% to 0.9% (odds ratio, 0.51; 95% confidence interval, 0.31-0.81; P < .01) but was significant only among nulliparous women. The cesarean delivery rate for second-stage arrest of labor decreased but not significantly between periods (1.3% vs 1.0%; odds ratio

2017 American Journal of Obstetrics and Gynecology

16. The Effects of Increased IV Hydration on Nulliparous Women Undergoing an Induction of Labor

intravascular volume), but also in reduced delivery of nutrients and elimination of waste products from the contracting myometrium. Inadequate maternal hydration has been postulated to be a contributing factor to prolonged or dysfunctional labor, in which uterine contractions are not sufficiently strong or are inappropriately coordinated to cause adequate cervical dilation and effacement. Even in patients who completely dilate, sufficient voluntary and involuntary muscle effort is required during the second (...) stage of labor to achieve a vaginal delivery. Prolonged labors can not only lead to increased hospitalization cost, but also to increased risks of cesarean delivery for indications such as "failure to progress," chorioamnionitis (intrauterine infection), and postpartum hemorrhage. Establishing techniques to optimize the length and duration of labor has therefore been an area of particular research interest. To date, several randomized, controlled studies have demonstrated that with higher

2016 Clinical Trials

17. Elevated amniotic fluid lactate predicts labor disorders and cesarean delivery in nulliparous women at term. (PubMed)

a standard oxytocin regimen up to a maximum dose of 30 mU/min was applied. AFL was measured using a point-of-care device (LMU061; ObsteCare, Stockholm, Sweden). Labor arrest in the first stage of labor was defined as the need for oxytocin when cervical dilatation was <1 cm/h over 2 hours and in the second stage of labor by poor descent and rotation over 1 hour. Standard statistical analysis included analysis of variance, Pearson correlations, and binary logistic regression. Unsupervised decision tree (...) Elevated amniotic fluid lactate predicts labor disorders and cesarean delivery in nulliparous women at term. We sought to assess amniotic fluid lactate (AFL) at diagnosis of spontaneous labor at term (≥37 weeks) as a predictor of labor disorders (dystocia) and cesarean delivery (CD).This was a single-institution, prospective cohort study of 905 singleton, cephalic, term (≥37 weeks) nulliparous women in spontaneous labor. A standard management of labor (active management of labor) including

2015 American Journal of Obstetrics and Gynecology

18. Evidence-based guidelines in labor management. (PubMed)

reached for the diagnosis of active phase labor, active phase arrest, second-stage arrest, protraction of the active phase, and failed induction of labor. Our review illustrates that slower labor patterns than traditionally described often result in a vaginal delivery without unacceptable increases in maternal or neonatal morbidity. (...) Evidence-based guidelines in labor management. Evidence-based care of women in labor requires a thorough understanding of both "normal" and abnormal labor progress. In response to the growing cesarean delivery rate for dystocia at our institution, a multidisciplinary team of attending physicians, nurse-midwives, resident physicians, and nurses was established to review the literature and create evidence-based guidelines. This article describes the background literature and consensus guidelines

2014 Obstetrical & Gynecological Survey

19. Normal Labor and Delivery (Overview)

dilatation curve is known as the Friedman labor curve, and a series of definitions of labor protraction and arrest were subsequently established. [ , ] However, subsequent data of modern obstetric population suggest that the rate of cervical dilatation is slower and the progression of labor may be significantly different from that suggested by the Friedman labor curve. [ , , ] Second stage of labor The second stage begins with complete cervical dilatation and ends with the delivery of the fetus (...) if this contraction pattern could not be achieved. This protocol achieved vaginal delivery rates of 56-61% in nulliparas and 88% in multiparas without severe adverse maternal or neonatal outcomes. Therefore, extending the criteria for active-phase labor arrest from 2 to at least 4 hours appears to be effective in achieving vaginal birth. [ , ] Second stage of labor When the woman enters the second stage of labor with complete cervical dilatation, the fetal heart rate should be monitored or auscultated at least

2014 eMedicine.com

20. Abnormal Labor (Follow-up)

: Does a prolonged second stage of labor in nulliparous women affect maternal and neonatal outcomes?. Am J Obstet Gynecol . 2004 Sep. 191(3):933-8. . Rinehart BK, Terrone DA, Hudson C, Isler CM, Larmon JE, Perry KG Jr. Lack of utility of standard labor curves in the prediction of progression during labor induction. Am J Obstet Gynecol . 2000 Jun. 182(6):1520-6. . El-Sayed YY. Diagnosis and management of arrest disorders: duration to wait. Semin Perinatol . 2012 Oct. 36(5):374-8. . Zhang J, Landy HJ (...) admission among singleton term nulliparous women with spontaneous onset of labor, vaginal delivery, and normal neonatal outcomes. Reprinted from Seminars in Perinatology, Vol 36(5), El-Sayed YY, Diagnosis and Management of Arrest Disorders: Duration to Wait, pgs 374-8, Oct 2012, with permission from Elsevier. of 5 Tables Table. Abnormal Labor Indicators Indication Nullipara Multipara Prolonged latent phase >20 h >14 h Average second stage 50 min 20 min Prolonged second stage without (with) epidural >2 h

2014 eMedicine.com

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