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Second stage of labour has been often neglected leading to increased maternal and perinatal morbidity. Recognising and managing prolonged second stage is a challenge even to an experienced obstetrician. This article reviews the changes in the definition of prolonged second stage over the years. It discusses the causes, recognition and management options along with the difficulties in delivering a patient with prolonged second stage of labour. Though adding an extra hour to the definition of second stage in patients may reduce the rate of caesarean section but some studies also show a rise in maternal and perinatal morbidity. Obstetricians are familiarized to the different techniques of delivery of the impacted head. Once diagnosis of prolonged second stage is confirmed, causes should be identified and addressed, and treatment should be individualised, and timing and mode of intervention planned.

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Background: The spectrum of liver disease is varied and is associated with increased maternal and perinatal morbidity and mortality when pregnancy coexists with the liver disease. This study aims to analyze the incidence, spectrum, clinical presentation and outcome of liver diseases complicating pregnancyMethods: A retrospective cohort study was conducted and data was collected from the hospital records of obstetric cases diagnosed with liver disease complicating pregnancy in a tertiary care hospital, over a period of two years.Results: A total 146 cases of liver diseases complicating pregnancies were recorded out of 5018 deliveries (2.9%). Intrahepatic cholestasis of pregnancy (n=52, 35.62%) and severe preeclampsia (n=47, 32.19%, with HELLP n=8, 5.48%) accounted for majority of cases. The incidence of chronic hepatitis B infection was 20.56% (n=30). There were two maternal deaths (1.37%) attributed to severe post-partum HELLP and severe preeclampsia with multi organ failure.Conclusions: Liver diseases in pregnancy have a non-specific presentation and may be associated with a wide range of conditions, early diagnosis and timely appropriate intervention can help reduce the mortality and morbidity.

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