title: Prolonged second stage of labor and risk of adverse maternal and perinatal outcomes: a systematic review.
abstract: BACKGROUND
  Safe and effective management of the second stage of labor presents a clinical challenge for laboring women and practitioners of obstetric care. This systematic review was conducted to evaluate evidence for the influence of prolonged second stage of labor on the risk of selected adverse maternal and neonatal outcomes.
  
  
  METHODS
  Articles were searched using PubMed, Cochrane Library, and CINAHL from 1980 until 2005. Studies were included according to 3 criteria: if they reported duration of the second stage of labor, if they reported maternal and/or neonatal outcomes in relation to prolonged second stage, and if they reported original research.
  
  
  RESULTS
  Our systematic review found evidence of a strong association between prolonged second stage and operative delivery. Although significant associations with maternal outcomes such as postpartum hemorrhage, infection, and severe obstetric lacerations were reported, inherent limitations in methodology were evident in the studies. Recurrent limitations included oversimplified categorization of second stage, inconsistency in study population characteristics, and lack of control of confounding factors. No associations between prolonged second stage and adverse neonatal outcomes were reported.
  
  
  CONCLUSIONS
  The primary findings of our review indicated that most of the studies are flawed and do not answer the important questions for maternity caregivers to safely manage prolonged second stage. Meanwhile, approaches for promoting a normal second stage of labor are available to caregivers, such as maternal positioning and pain relief measures and also promoting effective pushing technique.
authors.affiliation: Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, Washington, USA.
authors.forename: Molly R
authors.initials: MR
authors.lastname: Altman
authors.forename: Mona T
authors.initials: MT
authors.lastname: Lydon-Rochelle
mesh_terms: D000328:Adult; D036861:Delivery, Obstetric / Q000379:methods; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology* / Q000209:etiology; D007748:Labor Stage, Second; D009017:Morbidity; D007744:Obstetric Labor Complications / Q000401:mortality; D006473:Postpartum Hemorrhage / Q000453:epidemiology* / Q000209:etiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D011645:Puerperal Infection / Q000453:epidemiology* / Q000209:etiology; D012307:Risk Factors; D013997:Time Factors