A 30-year-old primigravida reaches full cervical dilatation. Two hours into the active second stage the head is at +2 station with adequate maternal pushing and good contractions, but the fetus remains in a direct occipito-posterior position and birth has not occurred. According to the durations taught, what does this indicate?

Answer: B. Delay in the active second stage requiring review

Duration of the second stage

The active second stage begins when the mother has the urge to bear down at full dilatation.

Expected durations

This case

• A primigravida at 2 hours without birth has reached the limit where delay should be recognised and senior advice sought.
• A persistent occipito-posterior position is a recognised cause of second-stage delay and prolonged labour.

Implication

Delay in the second stage prompts review for malposition or disproportion and a decision about assisted vaginal delivery or caesarean, depending on station, position and pelvic assessment.