Second-stage labor duration in nulliparous women: relationship to maternal and perinatal outcomes
Dwight J Rouse, Steven J Weiner, Steven L Bloom, Michael W Varner, Catherine Y Spong, Susan M Ramin, Steve N Caritis, Alan M Peaceman, Yoram Sorokin, Anthony Sciscione, Marshall W Carpenter, Brian M Mercer, John M Thorp Jr, Fergal D Malone, Margaret Harper, Jay D Iams, Garland D Anderson, Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network, Kenneth J Leveno, Elizabeth Thom, Allison Northen, Donald Mclntire, A Nothen, K Bailey, J Grant, S Tate, T Hill-Webb, J Tillinghast, D Allard, P Breault, N Connolly, J Silva, C Milluzzi, C Heggie, H Ehrenberg, B Stetzer, V Pemberton, S Bousleiman, H Husami, V Carmona, S South, M Talucci, M Pollock, M Sherman, C Tocci, E Seltzer, S Brody, J Granados, K Clark, J Mitchell, K Dorman, G Mallett, N Cengic, M Huntley, T Triplett, F Johnson, S Fyffe, M Landon, M Controneo, M Luce, H Birkland, M Bickus, L Creswell-Hartman, M C Day, F Ortiz, B Figueroa, S Shaunfield, M Messer, J McCampbell, L Moseley, K Anderson, B Oshiro, F Porter, K Jolley, A Guzman, M Swain, J Chilton, C Leftwich, W Davido, K Johnson, G Norman, B Steffy, C Sudz, S Blackwell, E A Thom, A Swanson, F Galbis-Reig, L Leuchtenburg, S Pagliaro, K Howell, Dwight J Rouse, Steven J Weiner, Steven L Bloom, Michael W Varner, Catherine Y Spong, Susan M Ramin, Steve N Caritis, Alan M Peaceman, Yoram Sorokin, Anthony Sciscione, Marshall W Carpenter, Brian M Mercer, John M Thorp Jr, Fergal D Malone, Margaret Harper, Jay D Iams, Garland D Anderson, Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network, Kenneth J Leveno, Elizabeth Thom, Allison Northen, Donald Mclntire, A Nothen, K Bailey, J Grant, S Tate, T Hill-Webb, J Tillinghast, D Allard, P Breault, N Connolly, J Silva, C Milluzzi, C Heggie, H Ehrenberg, B Stetzer, V Pemberton, S Bousleiman, H Husami, V Carmona, S South, M Talucci, M Pollock, M Sherman, C Tocci, E Seltzer, S Brody, J Granados, K Clark, J Mitchell, K Dorman, G Mallett, N Cengic, M Huntley, T Triplett, F Johnson, S Fyffe, M Landon, M Controneo, M Luce, H Birkland, M Bickus, L Creswell-Hartman, M C Day, F Ortiz, B Figueroa, S Shaunfield, M Messer, J McCampbell, L Moseley, K Anderson, B Oshiro, F Porter, K Jolley, A Guzman, M Swain, J Chilton, C Leftwich, W Davido, K Johnson, G Norman, B Steffy, C Sudz, S Blackwell, E A Thom, A Swanson, F Galbis-Reig, L Leuchtenburg, S Pagliaro, K Howell
Abstract
Objective: The purpose of this study was to assess maternal and perinatal outcomes as a function of second-stage labor duration.
Study design: We assessed outcomes in nulliparous laboring women who were enrolled in a trial of fetal pulse oximetry.
Results: Of 5341 participants, 4126 women reached the second stage of labor. As the duration of the second stage increased, spontaneous vaginal delivery rates declined, from 85% when the duration was <1 hour to 9% when it was > or =5 hours. Adverse maternal outcomes that were associated significantly with the duration of the second stage of labor included chorioamnionitis (overall rate, 3.9%), third- or fourth-degree perineal laceration (overall rate, 8.7%), and uterine atony (overall rate, 3.9%). Odds ratios for each additional hour of the second stage of labor ranged from 1.3-1.8. Among individual adverse neonatal outcomes, only admission to a neonatal intensive care unit was associated significantly with second stage duration (odds ratio, 1.4).
Conclusion: The second stage of labor does not need to be terminated for duration alone.
Source: PubMed