Perinatal Outcomes with Longer Second Stage of Labor: A Risk Analysis Comparing Expectant Management to Operative Intervention

Ausbeck, Elizabeth B.; Jennings, Sara; Champion, Macie L.; Gray, Meredith; Blanchard, Christina T.; Tita, Alan T.N.

doi:10.1055/s-0040-1708799

Cited by 9 publications

(10 citation statements)

References 14 publications

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“…Thuillier C and Zipori Y reported the new consensus recommendations was associated with the reduction of the rate of primary cesarean delivery [6,19]. Ausbeck EB's research showed prolonged second stage was associated with adverse maternal outcomes significantly, but not with adverse neonatal outcomes [20].…”

Section: Discussionmentioning

confidence: 99%

The impact of stage of labor on adverse maternal and neonatal outcomes in multiparous women: a retrospective cohort study

Wang

et al. 2020

BMC Pregnancy Childbirth

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Background The correlation between stage of labor and adverse delivery outcomes has been widely studied. Most of studies focused on nulliparous women, it was not very clear what impact the stage of labor duration had on multiparous women. Methods A retrospective cohort study was conducted among all the multiparous women of cephalic, term, singleton births, who planned vaginal delivery. The total stage of labor covered the first stage and the second stage in this study, and they were divided into subgroups. Adverse maternal outcomes were defined as referral cesarean delivery, instrumental delivery, postpartum hemorrhage, perineal laceration (III and IV degree), hospitalization stay ≥90th, and adverse neonatal outcomes as NICU, shoulder dystocia, Apgar score ≤ 7(5 min), neonatal resuscitation, assisted ventilation required immediately after delivery. Results There were 7109 parturients included in this study. The duration of first stage was 6.2(3.6–10.0) hours, the second stage was 0.3(0.2–0.7) hour, the total stage was 6.9(4.1–10.7) hours in multiparous women. At the first stage, the rates of overall adverse outcome were 21, 23.4, 28.8, 35.5, 38.4% in subgroups < 6 h, 6–11.9 h, 12–17.9 h, 18–23.9 h, ≥24 h, which increased significantly (X2 = 57.64, P < 0.001), and ARR (95% CI) were 1.10 (0.92,1.31), 1.33 (1.04,1.70), 1.80 (1.21,2.68), 2.57 (1.60,4.15) compared with subgroup < 6 h (ARR = 1); At the second stage, the rates of overall adverse outcome were 20.0, 30.7, 38.5, 61.2, 69.6% in subgroups < 1 h, 1–1.9 h, 2–2.9 h, 3–3.9 h, ≥4 h (X2 = 349.70, P < 0.001), and ARR (95% CI) were 1.89 (1.50, 2.39), 2.22 (1.55, 3.18), 10.64 (6.09, 18.59), 11.75 (6.55, 21.08) compared with subgroup < 1 h (ARR = 1)). At the total stage, the rates of overall adverse outcome were 21.5, 30.8, 42.4% in subgroups < 12 h, 12–23.9 h, ≥24 h (X2 = 84.90, P < 0.001), and ARR (95% CI) were 1.41 (1.16,1.72), 3.17 (2.10,4.80) compared with subgroup < 12 h (ARR = 1). Conclusions The prolonged stage of labor may lead to increased adverse outcomes in multiparous women, it was an independent risk factor of adverse maternal and neonatal outcomes.

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Section: Discussionmentioning

confidence: 99%

The impact of stage of labor on adverse maternal and neonatal outcomes in multiparous women: a retrospective cohort study

Wang

et al. 2020

BMC Pregnancy Childbirth

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“…The effect of the duration of the second stage of labor on perinatal outcomes has been well studied. E. B. Ausbeck’s retrospective cohort study showed that prolonged second stage was associated with adverse maternal outcomes such as PPH, chorioamnionitis, operative complications, postpartum infections, and ICU admission, but not with adverse neonatal outcomes [ 18 ]. Several studies also reported that multiparous women were at increased risk for operative deliveries, peripartum morbidity, and adverse neonatal outcomes with the second stage of 3 h or greater [ 7 , 10 ].…”

Section: Discussionmentioning

confidence: 99%

Association between the second-stage duration of labor and perinatal outcomes in women with a prior cesarean delivery

Zhang

Huang

et al. 2022

BMC Pregnancy Childbirth

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Background The cesarean delivery (CD) rate has been increasing globally. Trial of labor after cesarean delivery (TOLAC) has been used as a key method for the reduction of the CD rate. Little is known, however, about the association between the second-stage duration of TOLAC and adverse maternal and neonatal outcomes. This study evaluated the association between perinatal outcomes and the duration of second-stage labor in women undergoing TOLAC. Methods A 10-year retrospective cohort study was performed at the Department of Obstetrics and Gynecology, Third Affiliated Hospital of Guangzhou Medical University, between January 2010 and January 2020. Women undergoing TOLAC who reached the second stage of labor were included in this study. Duration of the second stage of labor was examined as a categorical variable (group I: <0.5 h, group II: 0.5–2 h and group III: ≥2 h) and as a continuous variable to evaluate the association with adverse perinatal outcomes by using multivariable regression models and a Cox proportional hazards regression model adjusting for potential confounders. Results Of the 1,174 women who met the inclusion criteria, the median (interquartile range) length of the second stage was 0.5 h (0.3–0.9 h). Among them, 1,143 (97.4%) delivered vaginally and 31 underwent an unplanned CD. As the second-stage duration increased, operative vaginal delivery (OVD), CD, and postpartum hemorrhage (PPH) rates increased. Women in group III had higher risks of OVD (aOR = 11.34; 95% CI [5.06–25.41]), CD (aOR = 4.22; 95% CI [1.32–13.43]), and PPH (aOR = 2.43; 95% CI [1.31–4.50]) compared with group I. Correspondingly, blood loss and the oxytocin used to treat PPH increased significantly, while the postpartum hemoglobin reduced significantly in group III compared with group I. The incidence of uterine rupture, uterine atony, cervical laceration, red blood cell transfusion, and intensive care unit admission were similar in all three groups. Neonatal outcomes were not affected by the second-stage duration. Conclusions Women undergoing TOLAC with second-stage duration of ≥2 h have higher odds of OVD, unplanned intrapartum CD, and PPH.

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“…By grouping the 2,140 cases with a group spacing of 60 minutes, we revealed that after 1 hour of second stage, each 60-minute increase in the length of labor did not significantly change neonatal UABGA pH, BE, or lactate, suggesting that the current limit of 4 hours (nulliparous) or 3 hours (multiparous) for the length of the second stage of labor does not significantly increase the risk of adverse outcomes such as metabolic acidosis in neonates. Previous studies showed that the effect of prolonged second stage of labor (>3 hours in nulliparous/2 hours in multiparous women) on neonatal outcome was inconclusive (12,13). However, they failed to discuss cases prolonged over 4 hours in the second stage of labor, as they were limited by the old management model of labor stage.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies showed that the effect of prolonged second stage of labor (>3 hours in nulliparous/2 hours in multiparous women) on neonatal outcome was inconclusive ( 12 , 13 ). However, they failed to discuss cases prolonged over 4 hours in the second stage of labor, as they were limited by the old management model of labor stage.…”

Section: Discussionmentioning

confidence: 99%

Does a longer second stage of labor worsen umbilical artery blood gas parameters in newborns?—a retrospective cohort study of 2,140 cases

Li¹,

He²,

Zhou³

et al. 2022

Ann Transl Med

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Background: With the application of the new labor management model in China, the normal length of the second stage of labor is significantly longer than that of the old model. It is unclear whether a longer stage of labor worsens umbilical artery blood gas analysis (UABGA) in newborns. The aim of this study was to investigate the correlation between the second stage of labor length, UABGA results, and neonatal intensive care unit (NICU) transfer rates under the new labor management model.Methods: This is a retrospective cohort study including full-term, cephalic, vaginal deliveries. Exclusion criteria were preterm deliveries or deliveries by cesarean section during labor. The pH, base excess (BE), and lactate results of UABGA in newborns clearly reflect neonatal metabolic acidosis and intrauterine oxygenation of the fetus. The correlation between the length of the second stage of labor and the results of UABGA and NICU transfer rate was analyzed using linear or logistic regression and curve fitting.Results: Of the total 2,140 cases, after adjusting for maternal age, gestational week, high-risk pregnancy factors, body mass index (BMI) before pregnancy, induced delivery, oxytocin during labor stage, labor analgesia, abnormal fetal position in labor stage, vaginal device delivery, length of first labor stage, and

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Perinatal Outcomes with Longer Second Stage of Labor: A Risk Analysis Comparing Expectant Management to Operative Intervention

Cited by 9 publications

References 14 publications

The impact of stage of labor on adverse maternal and neonatal outcomes in multiparous women: a retrospective cohort study

The impact of stage of labor on adverse maternal and neonatal outcomes in multiparous women: a retrospective cohort study

Association between the second-stage duration of labor and perinatal outcomes in women with a prior cesarean delivery

Does a longer second stage of labor worsen umbilical artery blood gas parameters in newborns?—a retrospective cohort study of 2,140 cases

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