not associated with longer second stage labor. Women who delivered within 0 to 1 hour had a spontaneous vaginal delivery (SVD) 90% of the time; those delivered in 2 to 3 hours had a 62.4% SVD rate, with 30.1% having operative vaginal delivery and 7.5%, CS; at Z3 hour, SVD rates dropped to 35.8%, with 37.4% having operative vaginal delivery, and 26.8%, CS.Epidural anesthesia was associated with an increased risk for operative vaginal deliveries, but not with higher CS rates in second stages exceeding 3 hours. Rates of thirddegree or fourth-degree perineal laceration, postpartum hemorrhage, chorioamnionitis, and endomyometritis increased with lengthening duration of second stage. Neonates delivered after a second stage of Z2 hours had higher undesirable neonatal outcomes, including 5-minute Apgar scores <7, umbilical artery pH <7, base excess < À 12, meconium-stained amniotic fluid, intensive care nursery admission, and prolonged hospital stays.A small subgroup of multiparous women do experience a second stage of labor >2 hours in duration. Whether to intervene depends on a thorough evaluation of the ongoing risks of the intervention versus further expectant management, along with patient preference. The authors believe their findings can help facilitate such a discussion and counseling of multiparous women in this situation. They recommended larger, randomized, controlled studies regarding intervention when the second stage of labor progresses beyond 2 hours in multiparous women.I n the late 1990s, the McRoberts maneuver was widely used in the United Kingdom to manage shoulder dystocia during vaginal delivery and protocols to overcome this complication had become established at most centers. This study investigated trends in shoulder dystocia prevalence, methods used to overcome the obstruction, and associated maternal, fetal, and neonatal morbidity at one medical center in the United Kingdom.Cases of shoulder dystocia from 1991 to 2005 were identified from maternal delivery records. Cases of brachial plexus injury and other neonatal diagnoses made during the same period were identified separately. The demographic and delivery statistics for all vaginal deliveries during each year were obtained. Information on shoulder dystocia management, once the condition was diagnosed, was also recorded. Neonate conditions at birth were assessed by recording APGAR scores, umbilical cord blood gases, evidence of orthopedic injury, and neurologic outcome. The level of obstetrician training was recorded. Maternal injury was documented as was management of subsequent deliveries, including recurrent shoulder dystocia and neonatal birth weight.Among 95,321 deliveries, 79,781 were vaginal and among these were 514 cases of shoulder dystocia, 44 cases of neonatal brachial plexus injury, and 36 asphyxiated neonates. The mean annual rate of vaginal deliveries was 82.4%, which decreased by 0.64% each year. Use of epidural analgesia averaged 28.3% annually. The overall rate of shoulder dystocia during the 15 year was 0.64% of vaginal deliv...

II.

Simple interventions to improve communication at handover and transfer can reduce the incidence of retained vaginal swabs and near misses. Further work is needed to raise the profile of swab counting in maternity settings: swab counting needs to be the responsibility of all disciplines, not just the responsibility of theatre staff.

The INFANT study is a randomised controlled trial to determine whether decision-support software for electronic fetal monitoring can reduce the number of babies born with poor outcomes compared to electronic fetal monitoring alone. A mixed methods sub-study was undertaken as part of INFANT to examine the effects of the technologies being used on the anxiety levels of those women randomised: 469 women were asked to measure their anxiety levels using a Visual analogue scale–anxiety (Vas-a) at three time points (two during labour and one postpartum). There was little difference in anxiety scores between the two groups and scores were positively correlated with stage of labour. This study concludes that the addition of decision-support software did not increase overall anxiety during labour. Furthermore, an additional 18 women were interviewed by a qualitative researcher to further assess anxiety in the study participants. From the sample it was concluded that where anxiety occurs it may be more to do with general anxiety about the baby's health, which may be prompted by a range of factors including staff behaviours and verbal communication rather than the addition of decision-support software to electronic fetal monitoring.