Multicenter, randomized, controlled trial of delayed pushing for nulliparous women in the second stage of labor with continuous epidural analgesia

Duration of passive and active phases of the second stage of labour and risk of severe postpartum haemorrhage in low-risk nulliparous women

“…Some randomised trials have assessed management of the passive second stage by measuring the impact of delayed pushing on the risk of PPH and found no difference between -early pushing‖ and -delayed pushing‖ groups, i.e., between women with shorter and longer periods of passive descent (16)(17)(18)(19). In accordance with these findings, we confirmed that the duration of the passive phase of the second stage did not appear to be associated with severe PPH.…”

When to stop pushing: effects of duration of second-stage expulsion efforts on maternal and neonatal outcomes in nulliparous women with epidural analgesia

“…Nulliparous women at term (≥ 37 weeks) with a singleton vertex fetus were eligible and randomized at the beginning of the second stage. Exclusion criteria were abnormal fetal heart rate monitoring during the first stage, maternal fever during the first stage of labor, adverse events during the pregnancy (hypertension, hemorrhage, fetal malformation, intra uterine growth retardation) and any condition that necessitated shortening of the second stage of labor (9). The clinical trial was approved by the Ethics Committee of Laval University.…”

“…The PEOPLE trial (Pushing Early Or Pushing Late with Epidural) is one such trial (9). A meta-analysis of these trials found a decreased risk of rotational or mid-pelvic instrumental deliveries in the delayed pushing group, but non significant reductions of instrumental deliveries, caesarean section and adverse neonatal outcomes (10).…”

Maternal and Neonatal Outcomes With Early Compared With Delayed Pushing Among Nulliparous Women

“…10 Randomized trials also have reported conflicting results, with some reporting decreases in time spent actively pushing, 11,12 others with no difference in time spent actively pushing or mode of delivery, 13,14 and another with a decrease in "difficult" deliveries but no difference in "nondifficult" vaginal deliveries. 15 A retrospective analysis by Frey et al reported delayed pushing to be associated with longer active pushing time, no change in or lower spontaneous vaginal delivery rate, and worse perinatal outcomes, including maternal fever and lower cord arterial pH. 16 The objectives of this analysis were two-fold.…”