Apgar score and cord pH in relation to length of second stage

Publisher Summary This chapter discusses a study to examine whether fetal heart rate recordings during the second stage could discriminate fetuses in jeopardy for those who do not require any assistance and for whom there is no benefit in intervention. During a 2-month period there were 172 deliveries of which 127, constituting a low risk group, were systematically investigated. These were term (37 to 41 completed weeks) singleton vaginal vertex deliveries with a normal course of pregnancy and normal first stage fetal heart rate recordings. Cases in which first stage fetal heart rate (FHR) showed decelerations, lack of reactivity, or lack of variability were excluded. Cords were clamped immediately and umbilical arterial and venous samples were collected within 10 seconds in a heparinized syringe. Apgar scores were carefully assessed by the midwives or paediatricians at 1, 5, and 10 minutes. There was no difference between the two groups. All patients were pushing actively. The decision to accelerate second stage with instrumental extraction or oxytocin was left to the discretion of the obstetrician. Although fetal heart rate has been extensively investigated during the first stage of labor, few reports have been specifically descriptive of the second stage. There is much controversy concerning the length of the second stage and the necessity of speeding birth in the interest of the neonate. Arguments have been based on neonatal state as assessed by blood gas analysis or Apgar score.