For example, the recent Eunice Kennedy Shriver National Institute of Child Health and Human Development document suggested allowing one additional hour in the setting of an epidural, thus, at least 3 hours in multiparous women and 4
hours in nulliparous women be used to diagnose second - stage arrest, although that document did not clarify between pushing time or total second stage (33).
Given the available literature, before diagnosing arrest of labor in the second stage and if the maternal and fetal conditions permit, at least 2 hours of pushing in multiparous women and at least 3 hours of
pushing in nulliparous women should be allowed (Table 3).
Haugen, M., Brantsaeter, A. L., Trogstad, L., Alexander, J., Roth, C., Magnus, P., and Meltzer, H. M. Vitamin D supplementation and reduced risk of
preeclampsia in nulliparous women.
A prolonged latent phase (eg, greater than 20
hours in nulliparous women and greater than 14 hours in multiparous women) should not be an indication for cesarean delivery.
In nulliparous women, a period of 8 hours of augmentation resulted in an 18 % cesarean delivery rate and no cases of birth injury or asphyxia, whereas if the period of augmentation had been limited to 4 hours, the cesarean delivery rate would have been twice as high given the number of women who had not made significant progress at 4 hours.
For women who had not progressed despite 4 hours of oxytocin (and in whom oxytocin was continued at the judgment of the health care provider), the vaginal delivery rates were 88 % in multiparous women and 56 %
in nulliparous women.
On the basis of the 95th percentile threshold, historically, the latent phase has been defined as prolonged when it exceeds 20 hours
in nulliparous women and 14 hours in multiparous women (18).