Abstract
Objective The aim of this study is to assess the impact of a prolonged second stage of labor
on maternal and neonatal outcomes by comparing women who had expectant management
versus operative intervention beyond specified timeframes in the second stage of labor.
Study Design Retrospective cohort including live singletons at ≥36 weeks who reached the second
stage of labor. Expectant management (second stage >3, 2, 2, and 1 hour in nulliparas
with an epidural, nulliparas without an epidural, multiparas with an epidural, and
multiparas without an epidural, respectively) was compared with those who had an operative
delivery (vaginal or cesarean) prior to these timeframes. The primary maternal outcome
was a composite of postpartum hemorrhage, chorioamnionitis, operative complications,
postpartum infections, and intensive care unit admission. The primary neonatal outcome
was a composite of cord blood acidemia, 5-minute Apgar's score <5, chest compressions
or intubation at birth, sepsis, seizures, birth injury, death, transfer to a long-term
care facility, and respiratory support for >1 day.
Results Among 218 women, 115 (52.8%) had expectant management. Expectant management was associated
with a significantly increased risk of the maternal composite (adjusted odds ratio
[aOR]: 1.99, 95% confidence interval [CI]: 1.09–3.64) but not the neonatal composite
(aOR: 1.54, 95% CI: 0.71–3.35).
Conclusion Expectant management of a prolonged second stage was associated with a higher rate
of adverse maternal outcomes, but the rate of adverse neonatal outcomes was not significantly
increased.
Keywords
cesarean - perinatal outcomes - prolonged labor - prolonged second stage - second
stage of labor
