The final stage of labor includes the time after the child is born to the delivery of the placenta. The second stage of labor ends once the fetus is delivered. Then, there is an extension of the head, which allows the fetal head to pass the maternal pubic symphysis, and finally, there is external rotation of the head, which allows the anterior shoulder to be delivered. Once the descent is complete, there is internal rotation, which enables the vertex of the fetal head to rotate away from the ischial spines located laterally. This flexion is then followed by descent when the fetus descends through the birth canal through the pelvis. Then, there is flexion of the head, which enables the occiput of the head of the fetus to be in a presentation position. The first of these movements is engagement, which occurs when the head of the fetus enters the lower pelvis. There are six cardinal movements of childbirth, all of which occur during the second stage of labor. The vertex, which is the top of the fetus’ head, normal rotates in either direction during the internal rotation portion of the cardinal movements during childbirth. The fetal position is defined as the position of the top of the fetus’ head in comparison to the plane of the maternal ischial spines when it is born. The fetal station is determined by the relationship between the fetal head and maternal ischial spines the station is defined from a range of -5 to +5, and 0 indicates that the fetal head is level with the maternal ischial spines. The fetal presentation is dictated by which fetal body part first passes through the birth canal most commonly, this is the occiput or the vertex of the head. ĭuring this stage, three clinical parameters are important to be aware of, which include fetal presentation, fetal station, and fetal position. Duration of this phase is variable and can last from minutes to hours however, the maximum amount of time that a woman can be in this phase of labor depends on the parity of the patient and whether the patient has an epidural catheter placed for anesthesia. The second stage of labor includes the time from complete cervical dilation, which is the end of the first stage to delivery of the fetus. It dilates slightly faster at a rate of 1.2 cm/hour in multiparous women. This phase is rapid in nulliparous women, the cervix dilates at an approximate rate of 1.00 cm/hour. The second sub-stage is known as the active phase, which includes the time from the end of the latent phase to the complete dilation of the cervix. The first sub-stage is known as the latent phase, which can last for several hours and starts from the cervical size of 0 cm to dilation of the cervix to 6 cm. The first stage of labor is divided into two sub-stages. The first stage of labor is the longest stage of labor it is the result of progressive and rhythmic uterine contraction which causes the cervix to dilate. The management of each stage varies, and exam findings during each of the stages can help identify short-term and long-term complications for the anticipated vaginal delivery such as fetal distress and hypoxemia, cord prolapse, placental abruption, uterine rupture, permanent disability, and maternal and/or fetal death. The labor leading to delivery of a full-term pregnancy is divided into three stages. The preterm birth rate was 9.9%, and the population’s birth rate was 11. According to the latest published data, in the USA, in 2017, there were 3,855,500 births, and 68% (2,621,010) of those were vaginal deliveries. Complications arise during each of the three stages, which can lead to the conversion of the anticipated vaginal delivery to operative cesarean delivery. The labor leading to the delivery is divided into 3 stages, and each stage requires specific management. Of note, with the advent of operative delivery modalities and surgical delivery modalities, the number of patients who reach spontaneous labor has decreased over time, and the induction of labor has increased. Approximately 80% of all singleton vaginal deliveries are at full-term via spontaneous labor, whereas 11% are preterm, and 10% are post-term. Vaginal delivery is preferred considering the morbidity and the mortality associated with operative cesarean births has increased over time. Vaginal delivery is safest for the fetus and the mother when the newborn is full-term at the gestational age of 37 to 42 weeks.
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