How long is too long: Does a prolonged second stage of labor in nulliparous women affect maternal and neonatal outcomes? - 25/08/11
, Linda M. Hopkins, MD, Aaron B. Caughey, MD, MPP, MPH
Reprint requests: Yvonne W. Cheng, MD, Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Maternal-Fetal Medicine, University of California, San Francisco, 505 Parnassus Ave, Box 0132, San Francisco, CA 94143.Abstract |
Objective |
The purpose of this study was to examine maternal and neonatal outcomes in relation to lengthening intervals of the second stage of labor.
Study design |
This is a retrospective cohort study of 15,759 nulliparous, term, cephalic, singleton births at the University of California, San Francisco, between 1976 and 2001. The second stage of labor was divided into 1-hour intervals. Maternal and neonatal outcomes were compared with the use of chi-squared and Student t tests, and a probability value of ≤.05 was used to indicate statistical significance. Potential confounders were controlled for with multivariate logistic regression.
Results |
Increasing rates of cesarean delivery, operative vaginal delivery, and perineal trauma were associated with the second stage beyond the first hour. In multivariate analysis, the >4-hour interval group had higher rates of cesarean delivery (odds ratio, 5.65; P < .001), operative vaginal deliveries (odds ratio, 2.83; P < .001), 3rd- or 4th-degree perineal lacerations (odds ratio, 1.33; P=.009), and chorioamnionitis (odds ratio, 1.79; P < .001). There were no differences in neonatal acid-base status associated with length of second stage. However, there were fewer neonates with a 5-minute Apgar score of <7 (odds ratio, 0.45; P=.01).
Conclusion |
Although the length of the second stage of labor is not associated with poor neonatal outcome, a prolonged second stage is associated with increased maternal morbidity and operative delivery rates.
Le texte complet de cet article est disponible en PDF.Key words : Second stage of labor, Complication, Mode of delivery
Plan
| Supported by the National Institute of Child Health and Human Development, Grant # HD01262 (A.B.C.). Presented at the Twenty-Fourth Annual Meeting of the Society for Maternal Fetal Medicine, New Orleans, LA, February 2-7, 2004. |
Vol 191 - N° 3
P. 933-938 - septembre 2004 Retour au numéro
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