According to contemporary ACOG criteria, in a nulliparous woman with neuraxial (epidural) analgesia, how long may the second stage of labour be permitted to continue, assuming maternal and fetal condition remain reassuring, before it is labeled arrested?
- A 2 hours
- B 3 hours
- C 4 hours ✓
- D 5 hours
Correct answer: C. 4 hours
Explanation
Contemporary ACOG criteria allow the second stage to extend up to 4 hours in a nulliparous woman with epidural analgesia before diagnosing arrest of the second stage, since longer patience reduces cesarean rates without increasing neonatal harm. Without an epidural the nulliparous limit is 3 hours, and multiparous women are allowed 2 hours, extended to 3 hours with neuraxial analgesia. Beyond these limits, continuing passively increases maternal infectious and hemorrhagic morbidity, prompting reassessment for operative vaginal delivery.
Reference: Williams Obstetrics, 26th ed.
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