Relationship between the Duration of the Second Stage of Labour and Neonatal Morbidity

Abstract

(1) Background: To assess the relationship between the duration of the second stage of labour and the neonatal morbidity risk; (2) Methods: An observational, analytical, retrospective cohort study was performed at the “Mancha-Centro” Hospital (Spain) during the 2013–2016 period. Data were collected from 3863 women who gave a vaginal birth. The studied neonatal morbidity variables were umbilical cord arterial pH, 5-min Apgar score, need for advanced neonatal resuscitation, and a composite neonatal morbidity variable on which the multivariate analysis was done. A univariate analysis was used for the potential risk factors and a multivariate analysis with binary logistic regression to control for possible confounding factors; (3) Results: The univariate analysis showed a statistically significant relationship between the duration of the second stage of labour and a high risk of advanced neonatal resuscitation and composite neonatal morbidity in multiparous women. However, after performing the multivariate analysis for the variable “composite neonatal morbidity”, we observed no relationship with the duration of the second stage of labour in either nulliparous or multiparous women; (4) Conclusions: The duration of the second stage of labour was not related to an increased risk of neonatal morbidity in our study population.

Relationship Between Prolonged Second Stage of Labor and Short-Term Neonatal Morbidity: A Systematic Review and Meta-Analysis

“…All studies were restricted to singleton infants with cephalic presentation. Eight of these articles studied nulliparous women [18,[20][21][22]28,[30][31][32], two studied multiparous women [19,23] and two studied both (nulliparous and multiparous women) [4,29]…”

“…Seven of the studies included in the meta-analysis [4,18,20,21,23,28,32] correctly defined prolonged second stage of labor (in this case, second stage of labor longer than 4 h in nulliparas and longer than 3 h in multiparas). Conversely, only three of them [18,21,28] established the maneuver used once prolonged second stage of labor was diagnosed (instrumental birth, continuing maternal pushing, caesarean, etc.…”

“…As for data and information collection, five studies [4,22,23,30,32] included missing or incomplete data as exclusion criteria, so they were not included in the analysis. To determine the relation between prolonged second stage of labor in nulliparous women (Table A3) and risk of low 5 min Apgar score (<7), six studies were included (n = 116,624) [4,18,28,[30][31][32].…”

“…To determine the relation between prolonged second stage of labor in multiparous women (Table A4) and risk of low 5 min Apgar score (< 7), three studies were included (n = 72,857) [4,19,23]. A significant increase in low 5 min Apgar score was observed when the second stage of labor lasted more than 3 h with respect to when the second stage of labor was ≤ 3 h (OR, 3.67; 95% CI 2.49-5.43).…”

“…No significant associations were reported between prolonged second stage in multiparous women and umbilical artery pH < 7.0, umbilical artery pH < 7.10, umbilical artery base excess ≥12, meconium aspiration, shoulder dystocia, prolonged neonatal stay, advanced neonatal resuscitation, birth depression, minor or major trauma or any perinatal morbidity. After combining two studies [19,29], only an increase in the risk of meconium staining was observed (OR, 1.29; 95%CI, 1.01-1.66), and an increase in composite neonatal morbidity (OR,1.97; 95% CI, 1.39-2.80) was observed after another two studies were combined [19,23] (Table 3).…”