Prolonged Second Stage: What Is the Optimal Length?

Publication/Presentation Date

11-1-2016

Abstract

IMPORTANCE: Prolonged second stage of labor is a clinical dilemma in which controversy exists on whether extending labor in nulliparous women with epidural anesthesia decreases the incidence of cesarean delivery without increasing maternal or neonatal risks.

OBJECTIVE: This narrative review was conducted to assess the current literature on management of and risks associated with a prolonged second stage in nulliparous women with epidurals.

EVIDENCE ACQUISITION: A review of the current literature was performed to evaluate the incidence of cesarean delivery and the maternal and neonatal outcomes.

RESULTS: A total of 11.5% of nulliparous women with epidurals have a prolonged second stage; 80.2% of these women deliver vaginally. There is 1 randomized controlled trial on prolonged second stage in nulliparous women with epidurals. In this study, extending the second stage beyond current guidelines decreased the incidence of cesarean delivery by 55% and did not increase maternal or neonatal risks. Most patients (75.6%) with a prolonged second stage delivered by 5 hours and had a vaginal delivery (80.5%). Women with a fetus in occiput anterior position or who presented in spontaneous labor had decreased risk of cesarean delivery (by 83% and 89%, respectively). Maternal risks include postpartum hemorrhage, chorioamnionitis, and third- and fourth-degree lacerations. Neonatal risks may have a small absolute increase.

CONCLUSIONS AND RELEVANCE: The change of a vaginal delivery is high (over 80%) beyond 3 hours in the second stage. Maternal and neonatal risks need to be further explored by larger, better-designed retrospective reviews or trials.

Volume

71

Issue

11

First Page

667

Last Page

674

ISSN

1533-9866

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

27901551

Department(s)

Administration and Leadership

Document Type

Article

Link to Full Text

Share

COinS