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.