A second-stage partogram

Abstract

Objective: To describe a second-stage partogram based on a system of scoring the descent and position of the fetal head and to use this system for studying progress in the second stage of labor and predicting mode of delivery and obstetric outcome. Methods: A prospective observational study of 1413 women at term with a singleton, cephalic presentation. The position and station of the fetal head were observed and scored at diagnosis of the second stage of labor, 1 hour later, and then at 30 minute intervals until delivery was achieved. The score at diagnosis of the second stage of labor was assessed for its ability to predict eventual mode of delivery and duration of labor. A normogram was defined for nulliparas and multiparas and was used to define normal and abnormal progress in the second stage, associated factors in the first stage of labor, and mode of delivery. Results: Increasing total score at the start of the second stage of labor is associated with increasing chance of spontaneous vaginal delivery (odds ratio [OR] 1.68 for nulliparas, 1.59 for multiparas), decreasing chance of instrumental vaginal delivery (OR 0.67 for nulliparas, 0.64 for multiparas), and emergency cesarean delivery (OR 0.39 for nulliparas). Abnormal progress as defined by the normogram is associated with use of epidural anesthesia, induction of labor, augmentation, dystocia, and increased incidence of operative delivery. No significant difference is found between normal and abnormal second stages of labor in fetal outcome as determined by Apgar scores. Conclusion: The second-stage partogram offers an objective basis for management of the second stage of labor.