The cumulative incidence of neonatal metabolic acidemia after terminal bradycardia in the 2nd stage of labor: a survival-based model

Does intrapartum epidural analgesia influence rate of emergency delivery for fetal compromise?

“…Damhuis et al showed that a prolonged second stage of labor (> 60 min) was associated in both nulliparous and parous women with emergency delivery for suspected fetal compromise, use of EDA during labor and increased risk of fetal compromise after EDA. This aligns with previous research showing an increased rate of instrumental delivery after EDA 12 and highlights that longer duration of labor, particularly the second stage, is a major risk factor for abnormal fetal CTG monitoring and neonatal acidemia [13][14][15] . Previous work has shown that the risk of neonatal acidemia is directly proportional to the duration of the second stage of labor, irrespective of the presence of CTG abnormalities, increasing 12-fold (1.2% to 15.3%) as the second-stage duration increased from 30 to 180 min 13 .…”

“…Previous work has shown that the risk of neonatal acidemia is directly proportional to the duration of the second stage of labor, irrespective of the presence of CTG abnormalities, increasing 12-fold (1.2% to 15.3%) as the second-stage duration increased from 30 to 180 min 13 . The risk of neonatal acidemia was also associated with the severity of CTG abnormalities, as expected, but was significantly greater than zero in the normal CTG group [13][14][15] . In view of this evidence, and the potential effects of the abovementioned risk factors on fetal compromise, prudence should be exercised when managing patients with EDA and fetal growth restriction, in order to minimize the duration of the second stage of labor.…”

Cesarean Delivery Uptake Trends Associated With Patient Features and Threshold for Labor Anomalies

“…However, longer labor duration may increase maternal and fetal risks. On the fetal side, recently published data found an increased risk of neonatal acidemia in longer second stages of labor, to different degrees depending on the normality or abnormality of cardiotocographic traces. Increased rates of abnormal intrapartum fetal monitoring can be expected owing to prolongation of labor, particularly the second stage, justifying both the finding of increased risk of cesarean delivery for nonreassuring fetal status and lower rate of labor arrest in the second phase of the study by Frappaolo and colleauges .…”

“…However, longer labor duration may increase maternal and fetal risks. On the fetal side, recently published data [5][6][7] found an increased risk of neonatal acidemia in longer second stages of labor, to different degrees depending on the normality or abnormality of cardiotocographic traces.…”

Does maternal oxygen administration during non-reassuring fetal status affect the umbilical artery gas measures and neonatal outcomes?

“…Based on our results, even in cases where fetal oxygen deprivation is suspected on FHR pattern and rapid delivery is required, oxygen administration may not be mandatory and the priority is to promote rapid delivery. Recent studies have reported that nulliparity, pathological CTG, and meconium-stained amniotic fluid results are significant predictors of MA (metabolic acidemia) at birth [ 15 , 16 ] and the duration of terminal bradycardia or duration of labor in the 2nd stage is associated with a risk of MA [ 15 , 17 ]. Cavoretto et al reported that the risk for MA increases moderately across the 2nd stage with non-pathological CTG and quadruples with pathological CTG requiring expedited delivery, especially rapidly over 120 min in the 2nd stage with pathological CTG.…”