Indicators for intervention during the expulsive second-stage arrest of labour.
OBJECTIVE
To identify antepartum and intrapartum indicators of obstetric interventions during the expulsive second-stage arrest of labour.


METHODS
Retrospective cohort study.


METHODS
The Netherlands.


METHODS
A cohort of 389,086 women with singleton, cephalic, term, live-birth deliveries from 2002 to 2004 who had entered the expulsive second stage of labour. Of all these deliveries, 37,899 (9.7%) were complicated by expulsive second-stage arrest of labour. Women with a prior Caesarean section or women undergoing an elective Caesarean section were excluded.


METHODS
All deliveries in the Netherlands from 2002 to 2004 were registered in the Netherlands Perinatal Registry, which contains the linked and validated data of three databases. Uni- and multivariable logistic regression analyses were performed.


METHODS
Ante- and intrapartum indicators for interventions during expulsive second-stage arrest of labour.


RESULTS
Primiparous delivery was the most important antepartum indicator for intervention during expulsive second-stage arrest. Using multivariable analysis the following antepartum indicators were associated with intervention for expulsive second-stage arrest of primiparous labour: maternal age, gestational age, diabetes, hypertension and labour induction. Prominent intrapartum indicators for primiparous deliveries were fetal head position and oxytocin augmentation.


CONCLUSIONS
Multiple significant antepartum and intrapartum indicators associated with intervention for expulsive second-stage arrest of labour were identified in this large retrospective study. Prominent were the associations of parity, maternal age and fetal head position with expulsive second-stage arrest. The identified factors should be further evaluated in prospective studies that aim to develop prediction models.
Leushuis
E
E
Department of Gynaecology and Obstetrics, Amsterdam Medical Center, Amsterdam, the Netherlands. e_leushuis@hotmail.com
Tromp
M
M
Ravelli
A C J
AC
van Huis
A M
AM
Mol
B W
BW
Visser
G H A
GH
van der Post
J A M
JA
D000293:Adolescent; D000328:Adult; D048909:Diabetes Complications / Q000453:epidemiology; D004420:Dystocia / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D004812:Epidemiologic Methods; D005260:Female; D005865:Gestational Age; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology; D007746:Labor Presentation; D007751:Labor, Induced / Q000009:adverse effects; D008423:Maternal Age; D009426:Netherlands / Q000453:epidemiology; D010298:Parity; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D055815:Young Adult