A primigravida with epidural analgesia has been fully dilated for 4 hours. She is pushing effectively, contractions are adequate, and the vertex is descending slowly. According to current ACOG criteria, at what total duration of the second stage in a nulliparous woman with epidural analgesia does 'prolonged second stage' begin?
- A 5 hours
- B 4 hours ✓
- C 3 hours
- D 2 hours
Correct answer: B. 4 hours
Explanation
ACOG defines prolonged second stage as 3 hours in a nullipara and 2 hours in a multipara, with an additional 1 hour allowed when epidural analgesia is used, giving 4 hours here. Without epidural the nulliparous limit is 3 hours, which is the trap in option C. Longer durations are acceptable if maternal and fetal status are reassuring and progress continues.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.