الفهرس 
Prolonged Second StageOnly 14 pages are availabe for public view
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Abstract
This study asses is intrapartum fetal head circumference asensitive major for diagnosis of prolonged second stage.
The second stage begins with complete cervical dilatation and end with delivery of fetus, prolonged second stage of labor should be considered when thesecond stage of labor exceeds 3 hours if regional anesthesia isadministered or 2 hours in the absence of regional anesthesia fornulliparas. In multiparous women, such a diagnosis can be made ifthe second stage of labor exceeds 2 hours with regional anesthesiaor 1 hour without it (Cunningham et al., 2010).
Studies performed to examine perinatal outcomes associatedwith a prolonged second stage of labor revealed increased risks ofoperative deliveries and maternal morbidities but no differencesin neonatal outcomes( cheng et al., 2004 / janni et al., 2002).
Maternal risk factors associated with a prolonged second stageinclude nulliparity, increasing maternal weight and/or weight gain,use of regional anesthesia, induction of labor, fetal occiput in aposterior or transverse position, and increased birth weight.(O’Connell et al., 2003 / Senécal et al., 2005).
Although the 2003 ACOG practice guidelines state that theduration of the second stage alone does not mandate intervention byoperative vaginal delivery or cesarean delivery if progress is beingmade, the clinician has several management options (continuingobservation/expectant management, operative vaginal delivery byforceps or vacuum-assisted vaginal delivery, or cesarean delivery)when second-stage arrest is diagnosed.
The association between a prolonged second stage of labor andadverse maternal or neonatal outcome has been examined. While aprolonged second stage is not associated with adverse neonataloutcomes in nulliparas, possibly because of close fetal surveillanceduring labor, but it is associated with increased maternal morbidity,including higher likelihood of operative vaginal delivery andcesarean delivery, postpartum hemorrhage, third- or fourth-degreeperineal lacerations, and peripartum infection(Martinet al.,2000).
Not much work has been done in the area of attempting to predict laboroutcome using dimensions of the fetal head. This study was aimed at determining whetherintrapartum (sonographic)head circumference has relationship with the second stage duration.Large FHC relative to maternal pelvic diameter, is the main cause of prolonged labor(Konje&Ladipo, 2000). And there forincreased riskof operative delivery (primary cesarean section, vacuum assisted and forceps-assisted vaginal delivery)(Elvander et al., 2012) .
Intra partum head circumference Is an integral part of sonographic models and important fo the purpose offetal weight estimation(Hadlock et al.,1982) as well as in cases whichabnormal fetal head growth is suspected (Hadlock et al.,1982) with somereviews suggesting that it can replace biparietal diameter(Weiner et al.,1985) .
Large study by Chervenak et al that evaluated pregnanciesconceived by in vitro fertilization and thus had known conception dates, headcircumference was found to be the best predictor of gestational age compared with othercommonly used parameters(Chervenak et al., 1991). This finding is in agreement with that ofHadlock(Hadlock et al., 1984), (Ott et al., 1994) and Benson(Benson et al., 1991) who compared the performance ofHC, BPD, FL and ACin different populations.
The study included 520 women with the diagnosis of the first of labor with at least cervical dilatation 4cm.
Each woman will be subject to:-
1. Careful and detailed history taking regarding personal history, complaint, past history, menstrual history and history of present pregnancy.
2. Abdominal examination is done to assesfetal movementsthe fundal height, number of fetuses, fetal lie, frequency and duration of uterine contraction if present.Auscultation of fetal heart sound was done by pinard’s stethoscope orsonicaid.
3. Local vaginal examination for assessment of.Presenting part for descent (station) presentation and position,state of membranes (intact or ruptured) and pelvic adequacy.
4. Ultrasound examination tofetal life, fetal lie and presentation, biometry for estimation of gestational age, amniotic fluid volume and turbidity.
Determination of fetal head circumference (primary outcome).
5. When the women is fully dilated. She transferred tooperating room and determination of the second stage length (second outcome).
6. Assessment of any vaginal laceration or perinatal tears.
7. Rate of caesarean section.
8. Rate of instrumental delivery.
The result showed there was significant association between intra partumfetal headcircumference (IPFHC) with gestational age, postpartumfetal headcircumference and fetal weight. And nosignificant association between intra partumfetal headcircumference and age, body mass index.
Receiver Operator characteristics curves (ROC) indicated that (IPFHC) ≤ 35.8 cm the best cut of level for predicting the prolonged second stage.
Cesarean delivery rate was24.5% among 121 women with small fetal headcircumference (≤ 35.8 cm) and 66.6 % among 42 women with large fetal headcircumference (≥ 35.8 cm).
Small fetal headcircumference (≤ 35.8 cm) showed short second stage with mean 35.12 minute and large fetal headcircumference (≥ 35.8 cm) show long second stage with mean 109 minute.