TY - JOUR
T1 - How long is too long
T2 - Does a prolonged second stage of labor in nulliparous women affect maternal and neonatal outcomes?
AU - Cheng, Yvonne W.
AU - Hopkins, Linda M.
AU - Caughey, Aaron B.
N1 - Funding Information:
Supported by the National Institute of Child Health and Human Development, Grant # HD01262 (A.B.C.).
PY - 2004/9
Y1 - 2004/9
N2 - The purpose of this study was to examine maternal and neonatal outcomes in relation to lengthening intervals of the second stage of labor. 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. 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). 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.
AB - The purpose of this study was to examine maternal and neonatal outcomes in relation to lengthening intervals of the second stage of labor. 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. 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). 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.
KW - Complication
KW - Mode of delivery
KW - Second stage of labor
UR - http://www.scopus.com/inward/record.url?scp=4644262520&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=4644262520&partnerID=8YFLogxK
U2 - 10.1016/j.ajog.2004.05.044
DO - 10.1016/j.ajog.2004.05.044
M3 - Article
C2 - 15467567
AN - SCOPUS:4644262520
SN - 0002-9378
VL - 191
SP - 933
EP - 938
JO - American journal of obstetrics and gynecology
JF - American journal of obstetrics and gynecology
IS - 3
ER -