An analysis of second-stage labor beyond 3 hours in nulliparous women.
OBJECTIVE
To analyze outcomes after second-stage labor beyond 3 hours and determine if prolonged second stages were intentional.


METHODS
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.


CONCLUSIONS
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.
Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75390-9032, USA.
April T
AT
Bleich
James M
JM
Alexander
Donald D
DD
McIntire
Kenneth J
KJ
Leveno
D000293:Adolescent; D000328:Adult; D015360:Analgesia, Epidural / Q000706:statistics & numerical data; D016362:Analgesia, Obstetrical / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002585:Cesarean Section / Q000706:statistics & numerical data; D002821:Chorioamnionitis / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D005323:Fetal Monitoring; D005334:Fever / Q000453:epidemiology; D006340:Heart Rate, Fetal; D006801:Humans; D020896:Hypovolemia / Q000453:epidemiology / Q000628:therapy; D007044:Hysterectomy / Q000706:statistics & numerical data; D007748:Labor Stage, Second; D022125:Lacerations; D010120:Oxytocics / Q000627:therapeutic use; D010121:Oxytocin / Q000627:therapeutic use; D010298:Parity; D010502:Perineum / Q000293:injuries; D011247:Pregnancy; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
D010120:Oxytocics; D010121:Oxytocin