A prolonged second stage of labor is defined as how long in a nulliparous woman with epidural analgesia (current ACOG 2014 guidelines)?

• A More than 1 hour
• B More than 2 hours
• C More than 4 hours
• D More than 3 hours ✓

Explanation

Per ACOG 2014 guidelines on safe prevention of primary cesarean: a prolonged second stage is defined as more than 2 hours without epidural (nulliparous) or more than 1 hour without epidural (multiparous). With epidural, add 1 hour to each: so nulliparous with epidural = >3 hours, multiparous with epidural = >2 hours. Importantly, the guidelines suggest cesarean should not be performed for prolonged second stage alone unless arrest occurs — operative vaginal delivery or continued pushing may be attempted if mother and fetus are stable.

Reference: Williams Obstetrics, 26th ed.

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Written and medically reviewed by the StethoPrep medical team.