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Protraction of descent
Descent of < 1 cm/h in nullips
Descent of < 2 cm/h in multips
Arrest of Descent
This requires an assessment of contractions, maternal
fetal well being, and CPD
CPD
Bad technique (eg pulling without contractions, upward
pull before crowning: deflexed, paramedian application
Large Caput
Shoulder dystocia
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If the anterior and posterior shoulders descend together instead of sequentially, the anterior
shoulder can become impacted behind the symphysis pubis (or the posterior shoulders on the
sacral promontory)
If descent of the fetal head continues while
the shoulders remain impacted, stretching of
the nerves of the brachial plexus can occur.
Careful documentation