[CG] Second stage of labour management in primigravid women in spontaneous labour with regional analgesia


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  • Confirmed Fully dilated by Midwife/Doctor
  • If undelivered after 1 hour: Reassess by same Midwife/Doctor for descent.

1.a. Positive descent >1cm and urge to push: commence active pushing

1.b. Positive descent > 1cm, and no urge to push: assess CTG, allow 1hr more if fetal condition satisfactory

                              If uterine activity < 3 good contractions in 10 mins commence Syntocinon.

2. No descent; Assess CTG. If no concern regarding Fetal Wellbeing commence Syntocinon IV

                              1 hour of Syntocinon then reassess and follow step 1.a. or 1.b.

It is important to assess maternal and fetal condition in context of delayed 2nd stage.

Note: if malposition of fetal head consider option of manual rotation to OA position if head below ischial spines. Even partial rotation may facilitate further rotation to DOA.

Last reviewed: 31 August 2017

Next review: 01 August 2022

Author(s): Dr. A.M. Mathers, Consultant Obstetrician, PRM on behalf of Obstetric Governance Group

Version: 2