A nulliparous woman with a working epidural has been actively pushing for 3.5 hours with steady descent. According to contemporary ACOG criteria, her second stage would be classified as:

• A Prolonged, because the limit is 2 hours with epidural anesthesia
• B Prolonged, because the limit for a nullipara is 3 hours regardless of epidural use
• C Normal, because the limit for a nullipara is 4 hours ✓
• D Normal, because epidural use removes any time limit on the second stage

Explanation

ACOG defines prolonged second stage as more than 3 hours in a nullipara and more than 2 hours in a multipara, each extended by 1 hour when epidural analgesia is used. So this nullipara with an epidural may push up to 4 hours before the stage is called prolonged. The distractor B ignores the epidural extension, which is exactly the detail being tested.

Reference: Williams Obstetrics, 26th ed.

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Written and medically reviewed by the StethoPrep medical team.