title: The management of the second stage of labour in women with cardiac: A mixed methods study.
abstract: OBJECTIVE
  To examine the duration of the passive and active parts of the second stage (SS) of labour in women with cardiac disease (CD) and to assess the adherence to antenatal care plans regarding timing of assisted delivery. Cardiac parameters were measured in a subset of women to investigate any differences between the passive and active SS of labour.
  
  
  METHODS
  Cohort study of 73 women with CD, classified into mWHO Class Groups I-IV. Women were matched with an equal number of women controlling for gestational age, maternal age (+/- five years), parity, use of regional anaesthesia, and spontaneous versus assisted delivery. 12 of the 73 women with cardiac disease had cardiac parameters and oxygen saturations measured in the active and passive SS of labours.
  
  
  RESULTS
  Length of passive SS was longer and the active component of the SS was significantly shorter in women with CD, because of a policy of elective assisted delivery. However, thirty four percent pushed for longer than was recommended. No adverse cardiac events were reported. Analysis of Holters showed no evidence of maternal arrhythmia in the active SS. Maternal heart rate increased at a modest but significant rate in the active SS.
  
  
  CONCLUSIONS
  Compliance with antenatal recommendations was poor; prolonged pushing was not associated with an increase in cardiac events. A restrictive policy for the duration of the active SS of labour in women with CD is currently based entirely on expert opinion and more prospective studies are needed justify this policy.
  West London Regional Ethics Committee REC reference: 13/LO/0042.
authors.affiliation: Academic Department of Obstetrics and Gynaecology, Imperial College London, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK. Electronic address: matthew.cauldwell@imperial.ac.uk.
authors.forename: Matthew
authors.initials: M
authors.lastname: Cauldwell
authors.affiliation: Adult Congenital Heart Centre, The National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Von Klemperer
authors.affiliation: Adult Congenital Heart Centre, The National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK.
authors.forename: Anselm
authors.initials: A
authors.lastname: Uebing
authors.affiliation: Adult Congenital Heart Centre, The National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK.
authors.forename: Lorna
authors.initials: L
authors.lastname: Swan
authors.affiliation: Academic Department of Obstetrics and Gynaecology, Imperial College London, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Steer
authors.affiliation: Adult Congenital Heart Centre, The National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Gatzoulis
authors.affiliation: Academic Department of Obstetrics and Gynaecology, Imperial College London, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Johnson
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006331:Heart Diseases / Q000628:therapy*; D006801:Humans; D007743:Labor, Obstetric; D010298:Parity; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012189:Retrospective Studies
keywords: Cardiac disease; Management; Second stage