Defining the upper limit of the second stage of labor in nulliparous patients

Predicting Route of Delivery Using Quantification of Maternal Expulsive Efforts in the Second Stage of Labor

“…When the labor curve was evaluated in terms of time (total second-stage time or effective second-stage time), spontaneous vaginal delivery trends and cesarean and operative vaginal delivery rates were consistent with prior studies of the second stage of labor. [14][15][16][17][18][19] In our study, there was no significant increase in maternal and neonatal composite outcomes as the number of pushing contractions increased. Prior studies have reported an increase in risk of maternal and neonatal complications as second-stage duration increases.…”

“…When the labor curve was evaluated in terms of time (total second-stage time or effective second-stage time), spontaneous vaginal delivery trends and cesarean and operative vaginal delivery rates were consistent with prior studies of the second stage of labor. 14–19…”

Inconsistent definitions of prolonged labor in international literature: a scoping review

“…We identified 43 studies that focused on defining a prolonged first and/or second stage of labor as primary outcome. 14 , 17 , 31 , 35 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 All of these studies, except four, originated from North America or Europe. 44 , 72 , 73 , 77 The majority were observational studies (35, 81.4%).…”

“…2 h/1 h for multiparous mentioned Cheng 2011 US 47 Retrospective cohort 7558 nulli with vaginal birth Prolonged second stage of labor Multiparous >3 h leads to increased risks. Definition of 3 h/2 h/2 h/1 h mentioned Finnegan 2019 IE 48 Prospective cohort 2336 nulliparous Prolonged second stage of labor Limiting to 2 h in nulliparous patients: 1 h passive, 1 h active Gimovsky 2016 US 49 RCT 78 nulliparous Prolonged second stage of labor >2 h nulliparous without EA, >3 h with EA. Extended group >3 h/>4 h, no significant difference on outcomes, less cesarean sections Gimovsky 2022 US 50 Survey 34 nulliparous Prolonged second stage of labor >3 or 4 h, extension no impact on pelvic floor dysfunction Grobman 2016 US 51 Retrospective cohort 53,285 Arrest of second stage of labor 2 h/3 h, longer duration on individualized basis Kadar 1986 GB 56 Retrospective cohort 410 nulli with vaginal birth Second stage duration 3 h, except for young women with GA < 40 w Le Ray 2011 FR 62 Prospective cohort 3330 nulli with vaginal birth Prolonged active/passive second stage of labor Active second stage usually maximum of 30 min, optimum needs to be found O'Connell 2003 GB 65 Case-control study 364 nulliparous Prolonged second stage of labor Long second stage >2 h, but compared up to 6 h Pham 2022 FR 66 Survey 8154 Prolonged second stage of labor Without EA: 89.6 min for nulliparous (90th centile) and 30.6 min multiparous.…”

“…The definitions of prolonged second stage of labor are almost exclusively based on absolute times, originally allowing 2 hours of second stage for nulliparous and 1 hour for multiparous women. 48 , 65 , 74 Most studies add an extra hour if epidural analgesia is used. 42 , 49 , 77 More recent studies allow up to four or even 6 hours for the second stage and some distinguish between the descending phase (sometimes up to 3 hours) and the actively pushing second stage (also defined as passive vs active second stage).…”