An extremely prolonged second stage of labor increases maternal complications but has no adverse effect on neonatal outcomes

Abstract

Aim To investigate how an extremely prolonged second stage of labor of 12 h or more affects maternal and neonatal outcomes. Material and methods This retrospective cohort study included nulliparous, pregnant women with 37 + 0 to 41 + 6 weeks of gestation whom vaginal delivery was attempted at the Yokohama City University Medical Center between 2014 and 2018. Results In 446 cases of the prolonged second stage of labor, there were 296 women (66%) in the 2‐ to 6‐h second stage of labor group, 112 women (25%) in the 6‐ to 12‐h group, and 38 women (8.5%) in the 12‐h or longer group. The longer the second stage of labor, the more significant was the increase in the rates of augmentation of the delivery, emergency cesarean delivery, and operative vaginal delivery. Even in the 12 h or longer group, 82% were able to have vaginal delivery. The 6‐ to 12‐h group had a significant increase in third‐ or fourth‐degree perineal lacerations compared to the 2‐ to 6‐h group (aOR 8.12 [95% CI 1.55–42.6]). Clinical chorioamnionitis was significantly increased in the 12 h or longer group (aOR 4.88 [95% CI 1.62–14.8]). In terms of neonatal outcomes, comparison between the three groups showed no significant difference. Conclusion With an extremely prolonged second stage of labor, maternal complications involved a significant increase in severe perineal lacerations and chorioamnionitis; however, there was no increase in adverse outcomes for neonates. It was not possible to conclusively determine if the duration of the second stage is acceptable.

The use of bubble charts in analyzing the global second-stage cesarean delivery rates: a systematic review

“…Moreover, 5 of the articles did not include information on elCD. 31 , 33 , 34 , 35 , 36 In addition, 17 articles provided information on ssCD-to-AVB ratio. The characteristics and the data of these 25 articles are listed respectively in Tables 2 and 3 and shown with a bubble chart ( Figure 2 ).…”

“…The characteristics and the data of these 25 articles are listed respectively in Tables 2 and 3 and shown with a bubble chart ( Figure 2 ). 2 , 3 , 23 , 24 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50

Figure 1 The PRISMA flowchart AJOG , American Journal of Obstetrics & Gynecology; PRISMA , Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

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“… 2 , 3 , 23 , 24 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50

Figure 1 The PRISMA flowchart AJOG , American Journal of Obstetrics & Gynecology; PRISMA , Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

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“…Moreover, 5 of the articles consisted of a mixture of both nulliparous and multiparous subjects, but none of the articles provided separate information according to parity except Hung et al 24 These 5 articles were grouped under group A ( Table 3 ), and its bubble chart is shown in Figure 2 , A. 2 , 3 , 23 , 24 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 The average pssCD/T of these 5 articles was 18.20% (reported range, 9.06%–30.26%). Their average ssCD/ssB was 0.83% (range, 0.19%–2.76%), whereas their average ssCD-to-AVB ratio was 0.09 (range, 0.05–0.28; available in 4 of 5 articles).…”

“…Group B consisted of 4 articles that also focused on singleton, term, cephalic presenting pregnancies as group A but of nulliparous subjects only. 30 , 33 , 34 , 36 As the article by Hung et al 24 in group A also provided separate data for different parity, their nulliparous subgroup was also extracted and tabulated in group B ( Table 3 ), and the bubble chart of group B is shown in Figure 2 , B. 2 , 3 , 23 , 24 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 Their average pssCD/T was 15.10% (reported range, 10.97%–32.59%).…”