Abstract
Objective To analyze outcomes after second-stage labor beyond 3 hours and determine if prolonged
second stages were intentional.
Study Design Retrospective cohort analysis of maternal and neonatal outcomes in nulliparous women
based on second-stage duration. Medical records were reviewed for management decisions
in women with second stages ≥4 hours; all other outcomes were accessed via computerized
obstetric database.
Results Second stage exceeding 3 hours occurred in 1489 (7%) of 21,991 pregnancies analyzed.
Of the 427 (2%) with second stages ≥4 hours, 315 (74%) reached 4 hours unintentionally,
after a decision for operative delivery had been made. Only 34 (8%) women were intentionally
allowed to continue second-stage labor beyond 4 hours, and half of these ultimately
required cesarean. Indices of maternal and neonatal morbidity were significantly increased
when second stages exceeded 3 hours.
Conclusion Most second stages reaching 4 hours are unintentional, occurring while awaiting an
previously decided upon operative delivery. Maternal and neonatal morbidities are
significantly increased with second stages beyond 3 hours.
Keywords
intentional - prolonged - second stage labor