How long is too long: Does a prolonged second stage of labor in nulliparous women affect maternal and neonatal outcomes?

Second-stage primary Caesarean deliveries: Are maternal complications increased?

“…1,2 Recently, some authors have extended the duration of the second stage to three hours because most nulliparous women who underwent regional anaesthesia were found to deliver within three hours of second-stage labour in comparison to two hours in those without regional analgesia. 3,4 More importantly, the extension of time given to the second stage of labour has been shown to increase the overall rate of vaginal births without adversely affecting neonatal morbidity. 3,4 However, maternal morbidities are increased and include operative vaginal delivery, anal sphincter tears, postpartum haemorrhage and emergency Caesarean sections (CSs).…”

“…3,4 More importantly, the extension of time given to the second stage of labour has been shown to increase the overall rate of vaginal births without adversely affecting neonatal morbidity. 3,4 However, maternal morbidities are increased and include operative vaginal delivery, anal sphincter tears, postpartum haemorrhage and emergency Caesarean sections (CSs). [5][6][7][8] Furthermore, the rates of CS have risen steadily in the past two decades and may be associated with a disproportionate rise in second-stage CS due to a decline in the use of instrumental deliveries.…”

“…[5][6][7][8] Furthermore, the rates of CS have risen steadily in the past two decades and may be associated with a disproportionate rise in second-stage CS due to a decline in the use of instrumental deliveries. 9 Most reports on second-stage CS originate in well-resourced countries [3][4][5][6][7][8] and tertiary academic institutions and have led to the Royal College of Obstetricians and Gynaecologists recommending the presence of a consultant obstetrician whenever a CS is performed in the second stage of labour. 9 In under-resourced settings, CSs are performed by medical doctors of varying experiences at different levels of health care.…”

Duration of passive and active phases of the second stage of labour and risk of severe postpartum haemorrhage in low-risk nulliparous women

“…Many authors report that a prolonged second stage is associated with maternal complications, especially postpartum haemorrhage (PPH) related to uterine atony (1)(2)(3)(4)(5)(6)(7). They studied the second stage of labour, beginning at full dilatation and finishing at birth, as an only one continuous phase.…”

A quality improvement tool - driver diagram: a model of driver diagram to reduce primary caesarean section rates

“…For example, Caesarean section for labour dystocia can be reduced by defining arrest after 4 hours of no cervical change. [12][13][14][15] A Partogram can be used to identify labour abnormalities. Similarly other secondary drivers for each primary driver are identified which are the areas of intervention or change.…”