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Randomized Controlled Trial
. 2009 Oct;201(4):357.e1-7.
doi: 10.1016/j.ajog.2009.08.003.

Second-stage labor duration in nulliparous women: relationship to maternal and perinatal outcomes

Dwight J Rouse  1 , Steven J Weiner, Steven L Bloom, Michael W Varner, Catherine Y Spong, Susan M Ramin, Steve N Caritis, Alan M Peaceman, Yoram Sorokin, Anthony Sciscione, Marshall W Carpenter, Brian M Mercer, John M Thorp Jr, Fergal D Malone, Margaret Harper, Jay D Iams, Garland D Anderson; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network
Collaborators, Affiliations
Randomized Controlled Trial

Second-stage labor duration in nulliparous women: relationship to maternal and perinatal outcomes

Dwight J Rouse et al. Am J Obstet Gynecol. 2009 Oct.

Abstract

Objective: The purpose of this study was to assess maternal and perinatal outcomes as a function of second-stage labor duration.

Study design: We assessed outcomes in nulliparous laboring women who were enrolled in a trial of fetal pulse oximetry.

Results: Of 5341 participants, 4126 women reached the second stage of labor. As the duration of the second stage increased, spontaneous vaginal delivery rates declined, from 85% when the duration was <1 hour to 9% when it was > or =5 hours. Adverse maternal outcomes that were associated significantly with the duration of the second stage of labor included chorioamnionitis (overall rate, 3.9%), third- or fourth-degree perineal laceration (overall rate, 8.7%), and uterine atony (overall rate, 3.9%). Odds ratios for each additional hour of the second stage of labor ranged from 1.3-1.8. Among individual adverse neonatal outcomes, only admission to a neonatal intensive care unit was associated significantly with second stage duration (odds ratio, 1.4).

Conclusion: The second stage of labor does not need to be terminated for duration alone.

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