Prediction of caesarean section for arrest of descent during the second stage of labour

Abstract

Background: Friedman described the normal progress of labor in different curves for nulliparous and multiparous women in 1954. Any deviation from these curves during the second stage of labor is considered as failure to progress in the second stage of labor. The aim of the study is to define obstetrical risk factors for arrest of descent during the second stage of labour.Methods: All singleton, vertex, term deliveries with an unscarred uterus, between December 2013 to November 2016 (3 years) were included. Univariable and multivariable analysis were performed to investigate independent risk factors associated with arrest of descent during the second stage of labor.Results: The study included 7260 deliveries, of these 163 (3.3%) were complicated with arrest of descent during the second stage of labor. Using a multivariable analysis, the following obstetric risk factors were found to be significantly associated with arrest of descent: primigravida (RR=7.8, 95% CI=6.9-8.7, p<0.001), obesity (RR=1.8, 95% CI=1.6-2.0, p<0.001), short stature (RR=2.3, 95% CI=1.9-2.8, p<0.001), hypertensive disorders(RR=1.5, 95% CI=1.3-1.8,p<0.001), gestational diabetes(RR=1.5, 95% CI=1.2-1.8, p<0.001), free floating head before labour(RR=3.4, 95%CI=2.5-4.1, p<0.001), Occipito-posterior position(RR=3.3, 95% CI=2.1-4.5, p<0.002), Prelabour rupture of membrane (PROM) (RR=1.3, 95% CI=1.0-1.6, p<0.02), induction of labour (RR=2.2, 95% CI=1.0-3.4, p<0.03) and birth weight>3.5 kg (RR=2.2, 95% CI=2.0-2.4, p<0.001). Deliveries complicated by arrest of descent resulted in cesarean section in 67% and 34% vaginal delivery.Conclusions: In this era of increased public awareness and medicolegal events it is very crucial to assess and evaluate every woman in labor and to identify in advance the possibility of arrest in advanced labor so that a timely obstetric intervention possibly Cesarean section can prevent unnecessary maternal- fetal complications.

Prolonged passive second stage of labor in nulliparous women—Prevalence and risk factors: A historical cohort study

“…Induction of labor has been associated with an increased risk for arrest of descent in the second stage 4,8 . This was not supported in our study, where results showed no increased risk for prolonged passive second stage ( p = 0.5), irrespective of the induction method.…”

“…Induction of labor has been associated with an increased risk for arrest of descent in the second stage. 4 , 8 This was not supported in our study, where results showed no increased risk for prolonged passive second stage ( p = 0.5), irrespective of the induction method. The incidence of induction of labor in the study population was 20.6%, matching the national rate for nulliparous women of 20.3%.…”

“…Little is known about factors that influence the passive second stage in nulliparous women. A few studies have identified factors associated with the arrest of fetal descent, but these have only described births necessitating operative delivery, included a combination of nulli‐ and multiparous women and lacked information on spontaneous vaginal deliveries and whether immediate or delayed pushing was standard management 3,4,8 . The aim of this study was thus to study the prevalence of and risk factors for prolonged passive second stage in nulliparous women.…”

Prolonged passive second stage of labour in nulliparous women: A multi perspective study

“…Two international studies report on arrest of descent during the second stage in nulli-and parous women that necessitated operative delivery. The prevalence was 1.7% (42) and 3.3% (43). A Swedish study found a prevalence of the passive second stage duration >2h in 23.4% of the nulliparous women (n= 410) (44) and another 25.6% (n=597) (45).…”

“…A few studies have previously described risk factors for the prolonged passive second stage, finding associations with nulliparity, hypertensive disorders (chronic or pregnancy induced), gestational diabetes, hypothyroidism, birth weight >3.5 kg, premature rupture of membranes (43), induction of labour (2,42,43) and epidural analgesia (2,42). There are conflicting results regarding higher maternal BMI where it has been found to either increase (47) or decrease (48)(49)(50) the duration of the second stage.…”