How does the duration of active pushing in labor affect neonatal outcomes?

Yli, Branka M.; Kro, Grete A.B.; Rasmussen, Svein; Khoury, Janette; Norén, Håkan; Amer‐Wåhlin, Isis; Saugstad, Ola Didrik; Stray‐Pedersen, Babill

doi:10.1515/jpm.2011.126

Cited by 8 publications

(5 citation statements)

References 31 publications

(31 reference statements)

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“…Likewise, EPO levels in the umbilical cord blood are higher after uncomplicated vaginal birth than after elective CS [ 30 ]. This is explained by reduced placental perfusion caused by prolonged uterine contractions in combination with maternal bearing down efforts [ 31 ]. Since diabetes mellitus is associated with an increased prevalence of vascular diseases, high rates of fetal distress may possibly be explained by vascular changes in the placental circulation, causing reduced placental perfusion.…”

Section: Discussionmentioning

confidence: 99%

Peripartum fetal distress in diabetic women: a retrospective case-cohort study

Castelijn

Hollander

Hensbergen

et al. 2018

BMC Pregnancy Childbirth

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BackgroundMajor concerns of pregnancies complicated by diabetes mellitus are an increased risk of adverse perinatal outcome. The objective of this study was to analyse the rate of fetal distress during labor in women with type 1, type 2 and gestational diabetes compared to control women.MethodsA retrospective case-cohort study was conducted at the VU University Medical Center, Amsterdam; a tertiary care hospital. 117 women with type 1 diabetes, 59 women with type 2 diabetes, 303 women with gestational diabetes and 15,260 control women were included, who delivered between March 2004 and February 2014. Linear and logistic regression analyses were used to compare maternal and pregnancy characteristics. Risk of fetal distress and perinatal asphyxia was assessed by multiple regression analyses, adjusted for confounding factors as age, smoking, parity, previous cesarean section, hypertensive disorder, pre-eclampsia, prematurity, induction of labor and macrosomia. Main outcome measure was fetal distress, defined either as clinical indication for instrumental or cesarean delivery; or low umbilical artery pH (UA pH), or admission to neonatal unit (NU).ResultsThe indication for instrumental or cesarean delivery in women with type 1 and type 2 diabetes mellitus was more frequently based on fetal distress as compared to controls (adjusted OR 2.76 CI 1.74–4.40 and adjusted OR 2.31 CI 1.19–4.51, respectively). In comparison with the control group, infants of women with type 1 diabetes had an increased risk of UA pH < 7.20 (adjusted OR 1.88 CI 1.23–2.87) or UA pH < 7.10 (adjusted OR 3.35 CI 1.79–6.27). Also, infants of women with type 1 diabetes were at increased risk for admission to NU as compared to infants of control women (OR 8.07 CI 4.75–13.70).ConclusionsWomen with type 1 and type 2 diabetes are at increased risk of fetal distress during labor as compared to controls.

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Section: Discussionmentioning

confidence: 99%

Peripartum fetal distress in diabetic women: a retrospective case-cohort study

Castelijn

Hollander

Hensbergen

et al. 2018

BMC Pregnancy Childbirth

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“…This review reports that, although most studies included prospectively collected data, there were several limitations to the studies, such as unclear or oversimplified categorizations of second stage of labor that did not consider parity or analgesia, different definitions of the onset of second stage of labor, lack of data on confounding factors and absence of analyses of effect modification. To our knowledge, only two studies included individual data on epidural analgesia as a confounder in the analyses [25,26] but there is no report on whether epidural analgesia was tested for effect modification.…”

Section: Discussionmentioning

confidence: 99%

Prolonged second stage of labor is associated with low Apgar score

et al. 2015

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There is no consensus on the effects of a prolonged second stage of labor on neonatal outcomes. In this large Swedish population-based cohort study, our objective was to investigate prolonged second stage and risk of low Apgar score at 5 min. All nulliparous women (n = 32,796) delivering a live born singleton infant in cephalic presentation at ≥37 completed weeks after spontaneous onset of labor between 2008 and 2012 in the counties of Stockholm and Gotland were included. Data were obtained from computerized records. Exposure was time from fully retracted cervix until delivery. Logistic regression analyses were used to estimate crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs). Adjustments were made for maternal age, height, BMI, smoking, sex, gestational age, sex-specific birth weight for gestational age and head circumference. Epidural analgesia was included in a second model. The primary outcome measure was Apgar score at 5 min <7 and <4. We found that the overall rates of 5 min Apgar score <7 and <4 were 7.0 and 1.3 per 1000 births, respectively. Compared to women with <1 h from retracted cervix to birth, adjusted ORs of Apgar score <7 at 5 min generally increased with length of second stage of labor: 1 to <2 h: OR 1.78 (95% CI 1.19-2.66); 2 to <3 h: OR 1.66 (1.05-2.62); 3 to <4 h: OR 2.08 (1.29-3.35); and ≥4 h: OR 2.71 (1.67-4.40). We conclude that prolonged second stage of labor is associated with an increased risk of low 5 min Apgar score.

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“…The declining trend in newborns with low umbilical artery pH was not observed until 2012 and 2013. This may be due to an increased vigilance concerning the maximum dose of oxytocin used and reduced overall use of oxytocin, particularly in the second stage of labor .…”

Section: Discussionmentioning

confidence: 99%