Assessment
Slow progress of second stage requires clinical reassessment of the women and the fetus. Assessment should be made of fetal size, adequacy of the pelvis, fetal wellbeing, and maternal pushing efforts. The abdomen should be palpated for a prompt and thorough clinical assessment to rule out full bladder, and abdominal examination may reduce the number of vaginal exams that are necessary. Vaginal examination should be offered to evaluate the state of the membranes and amniotic fluid characteristics, bleeding, discharge, effacement of the cervix, fetal presenting part, position and descent or the presence of caput or moulding. If characteristics such as large caput, third degree moulding, cervix poorly applied to presenting part, oedematous cervix, ballooning of lower uterine segment, formation of retraction band, or maternal or fetal distress are present, obstructed labour or cephalopelvic disproportion should be suspected.