Second-stage labor duration in nulliparous women: relationship to maternal and perinatal outcomes

Abstract

Objective To assess maternal and perinatal outcomes as a function of second stage labor duration. Methods We assessed outcomes in nulliparous laboring women enrolled in a trial of fetal pulse oximetry. Results Of 5,341 participants, 4,126 reached the second stage. As duration of the second stage increased, spontaneous vaginal delivery rates declined, from 85% when the duration was under one hour to 9% when it was 5 hours or more. Adverse maternal outcomes significantly associated with the duration of the second stage included chorioamnionitis (overall rate 3.9%), 3rd or 4th degree perineal laceration (8.7%), and uterine atony (3.9%). Odds ratios (ORs) for each additional hour of the second stage ranged from 1.3 to 1.8. Among individual adverse neonatal outcomes, only admission to a neonatal intensive care unit was significantly associated with second stage duration (OR 1.4). Conclusions The second stage does not need to be terminated for duration alone.

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

“…[2][3][4] Similarly, the International Federation of Gynecology and Obstetrics recommends waiting up to four hours for the nulliparous women to experience the urge to push before initiating active pushing. 5 While a long second stage 6,7 and prolonged active pushing in the second stage 8 have been associated with an increased risk of adverse maternal and neonatal outcomes, data on the maternal and neonatal risks associated with delayed pushing are conflicting. Some data suggest delayed pushing is associated with less active pushing time 9,10 and increased likelihood of spontaneous vaginal delivery.…”

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

“…Many authors report that a prolonged second stage is associated with maternal complications, especially postpartum haemorrhage (PPH) related to uterine atony (1)(2)(3)(4)(5)(6)(7). They studied the second stage of labour, beginning at full dilatation and finishing at birth, as an only one continuous phase.…”

Postpartum Haemorrhage; Frequency in Obese Primigravid Women

“…Rate of PPH is higher in emergency C-section as compared to elective C-section, consistent with the study by Rouse DJ etal. 16 Another study has also primarily explored the relationship between maternal obesity and PPH 17 while Blomberg reported little increased risk in obese women following vaginal delivery, but the PPH risk was variable according to class of obesity following caesarean section.…”