Contemporary patterns of labor in nulliparous and multiparous women

Ashwal‏, Eran; Livne, Michal; Benichou, Jennifer I. C.; Unger, Ron; Hiersch, Liran; Aviram, Amir; Mani, Ariel; Yogev, Yariv

doi:10.1016/j.ajog.2019.09.035

Cited by 42 publications

(27 citation statements)

References 17 publications

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“…It was known that the stage of labor of multiparous women was shorter than that of nulliparous women [10], but it was not very clear what impact the duration of first stage and second stage of labor had on delivery outcomes in multiparous women. We assumed that the prolonged stage of labor might also lead to increased adverse outcomes.…”

Section: Introductionmentioning

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: Introductionmentioning

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 lower rate of epidural uptake in multiparous labouring women is potentially due to the shorter average duration of labour. As a result, not only will this have an impact on their decision‐making process, but it also limits the window of opportunity for effective insertion, especially in patients who had precipitous labour, hence the low epidural numbers observed in this group 15 . Multiparous women who had induced and augmented labours were more likely to request an epidural due to the intensity of the contractions and longer duration of labour 2,7,16 …”

Section: Discussionmentioning

confidence: 99%

Obstetric anal sphincter injuries (OASIS) in multiparous women with the use of epidural anaesthesia: A retrospective cohort study

Putri

Simons

Nettle

et al. 2020

Aust NZ J Obst Gynaeco

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Background The use of epidural as a form of analgesia is increasingly common in labour, but this has shown to have been associated with increased rates of instrumental delivery, and prolonged second stage, resulting in increased rates of OASIS (Obstetric Anal Sphincter Injury). Aims This study aimed to investigate the impact of epidural anaesthesia in multiparous women undergoing vaginal deliveries on OASIS and secondary maternal outcomes. Materials and Methods A retrospective cohort study of multiparous women with singleton pregnancies delivering at term ≥37 weeks and the use of epidural analgesia in labour at a tertiary hospital in Melbourne, Victoria, Australia, the Royal Women's Hospital was undertaken between the period 2012–2018. Maternal outcomes were collated and dichotomised according to the presence of epidural use. Multiparous women with no prior history of a vaginal birth and non‐cephalic presentation during labour were excluded. Results There were 14 124 multiparous women who met the inclusion criteria; spontaneous labour is associated with an increased risk of OASIS at adjusted odds ratio (aOR) 1.46, P = 0.012. The overall rate of epidural use was 17%. Women with epidural use had significantly lower chances of sustaining OASIS in normal vaginal births and instrumental vaginal births. (1% vs 1.8%, aOR 0.49, P = 0.004). Epidural is associated with increased rates of prolonged second stage (8.5% vs 3.8%, P < 0.05), instrumental delivery (26.1% vs 4%, P < 0.05), and episiotomy use (23.8% vs 10.2%, P < 0.05). Conclusion The use of epidural analgesia in multiparous women is associated with a reduction in anal sphincter injuries.

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“…In this study, the total stage was covered first and second stages before delivery, because first stage and second stage cannot be absolutely distinguished sometimes. The duration of first labor stage in multiparous women was shorter than in nulliparous [7]. In nulliparous women, the prolonged first or second stage of labor was related to adverse outcomes [5,[8][9][10], and there was a correlation between the first and second stages of labor [11].…”

Section: Introductionmentioning

confidence: 94%

The Impact of Labor Stage Duration on Adverse Maternal and Neonatal Outcomes in Multiparous Women: A Retrospective Cohort Study

wang

Wang

et al. 2020

Preprint

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Background The duration of first and second stages of labor was increased in the consensus that American College of Obstetricians and Gynecologists (ACOG) published 2014. Studies showed increased adverse maternal and neonatal outcomes in nulliparous women with prolonged second stage of labor. It is not very clear that the impact of labor stage duration on multiparous women.Methods A retrospective cohort study was performed. Cephalic, term, singleton multiparous women were included, who planned for vaginal delivery. Adverse maternal outcomes were defined as referral cesarean delivery, instrumental delivery, postpartum hemorrhage, perineal laceration (3rd and 4th degree), hospitalization stay ≥ 90%th, and adverse neonatal outcomes as NICU, shoulder dystocia, Apgar score ≤ 7(5 min), neonatal resuscitation, assisted ventilation required immediately after delivery. We defined the total stage included the first and second stage of labor.Results There were 7109 parturients included, The duration of first stage was 6.2(3.6–10.0) hours in multiparous women, the second stage was 0.3(0.2–0.7) hours, the total stage was 6.9(4.1–10.7) hours. In the first stage, the rate of overall adverse outcomes was 21%, 23.4%, 28.8%, 35.5%, 38.4% in < 6 h, 6-11.9 h, 12-17.9 h, 18-23.9 h, ≥ 24 h, increased significantly (X2 = 57.64, P๤0.001). Compared with < 6 h, 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);In the second stage, the rate of overall adverse outcomes increased from 20.0%, 30.7%, 38.5%, to 61.2%, 69.6% in < 1 h, 1-1.9 h, 2-2.9 h, 3-3.9 h, ≥ 4 h (X2 = 349.70, P๤0.001). Compared with < 1 h, 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); In the total stage, the rate of overall adverse outcomes were 21.5%, 30.8%, 42.4% in < 12 h, 12-23.9 h, ≥ 24 h (X2 = 84.90, P๤0.001). Compared with < 12 h, ARR (95% CI) were 1.41(1.16,1.72), 3.17 (2.10,4.80).Conclusions The prolonged labor stage may lead to increased adverse outcomes in multiparous women, even in the first stage. The duration of labor stage was an independent risk factor for adverse maternal and neonatal outcomes.

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Contemporary patterns of labor in nulliparous and multiparous women

Cited by 42 publications

References 17 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

Obstetric anal sphincter injuries (OASIS) in multiparous women with the use of epidural anaesthesia: A retrospective cohort study

The Impact of Labor Stage Duration on Adverse Maternal and Neonatal Outcomes in Multiparous Women: A Retrospective Cohort Study

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