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

Abstract

Introduction This study examined the prevalence of and risk factors for a prolonged passive second stage of labor in nulliparous women. Material and Methods This was a historical cohort study of all nulliparous women (n = 1131) at two delivery units in Sweden. Maternal and obstetric data were obtained from electronic medical records during 2019. Duration of the passive second stage was measured as time from retracted cervix to start of pushing. Prolonged passive second stage was defined as ≥2 h. Prevalence was calculated and associations between prolonged passive second stage and maternal, obstetric and neonatal characteristics and potential risk factors were assessed using logistic regression models. Results The prevalence of prolonged passive second stage was 37.6%. Factors associated with an increased risk of prolonged passive second stage were epidural analgesia (adjusted odds ratio [aOR] 3.93; 95% confidence interval [CI] 2.90–5.34), malpresentation (aOR 2.26; 95% CI 1.27–4.05), maternal age ≥ 30 years (aOR 2.00; 95% CI 1.50–2.65) and birthweight ≥ 4 kg (aOR 1.50; 95% CI 1.05–2.15). Maternal body mass index ≥30 (aOR 0.52; 95% CI 0.34–0.79) and noncohabiting (aOR 0.51; 95% CI 0.30–0.89) reduced the odds of prolonged passive second stage. Conclusions A prolonged passive second stage of labor in nulliparous women is common (n = 425 [38%]). We found epidural analgesia, malpresentation, maternal age ≥ 30 years and birthweight ≥4 kg to be major risk factors associated with an increased risk of a prolonged passive second stage. Birth outcomes for prolonged passive second stage need to be investigated to strengthen evidence for the management of the second stage of labor.

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

“…We identified 189 studies with study objectives other than arriving at a definition of prolonged labor, but which specified a definition of prolonged labor or a synonym. 1 , 2 , 3 , 22 , 28 , 32 , 33 , 34 , 36 , 37 , 38 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 , 113 , 114 , 115 , 116 , 117 , 118 , 119 , 120 , 121 , 122 , 123 , 124 , 125 , 126 , 127 , 128 , 129 , 130 , …”

Risk Factors for Prolonged Intertwin Delivery Interval and Associated Maternal and Second Twin Morbidity

“…However, these two studies involved a small sample size and set the IDI of interest at >30 minutes. Other reports 9 10 13 16 21 22 did not address these variables at all. Advanced maternal age and nulliparity have previously been marked as predictors of prolonged second stage of labor in singleton deliveries.…”

“…Advanced maternal age and nulliparity have previously been marked as predictors of prolonged second stage of labor in singleton deliveries. [22][23][24]…”

Mode of delivery and birth outcomes in relation to the duration of the passive second stage of labour: A retrospective cohort study of nulliparous women

“…This is especially important when risk factors for prolonged labour is prevalent. Epidural analgesia and fetal malposition has previously been associated with an increased risk of prolonged passive second stage (≥2 hours) [ 48 ] and persistent occiput posterior position is associated with increased risk of operative delivery [ 49 ]. These factors need to be addressed in the clinical evaluation of longer duration of the passive second stage.…”

“…We addressed the issue of a cut-off time for an operative delivery due to a prolonged passive second stage in the light of maternal and neonatal safety in this study. A previous study from our research group has shown a rate of 38% for the duration of the passive second stage ≥2h [ 48 ]. We thus chose to categorize the population into three groups (0 to <2 h, 2- <4h and ≥4h) in this study to increase the clinical relevance for decision-making on expectant management or operative delivery.…”