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Am J Obstet Gynecol. 2007 Jun;196(6):585.e1-6.

Duration of the second stage of labor in multiparous women: maternal and neonatal outcomes.

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Division of Perinatal Medicine and Genetics, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, School of Medicine, San Francisco, CA, USA.



This study was undertaken to examine perinatal outcomes associated with the second stage of labor in multiparous women.


This is a retrospective cohort study of all term, cephalic, singleton births delivered by multiparous women between 1991 and 2001. Duration of the second stage of labor was stratified into hourly intervals: 0-1 hour, 1-2 hours, 2-3 hours, and 3 hours or longer. Perinatal outcomes were analyzed by using chi2 test and multivariable logistic regression models, by using P<.05 and 95% CI to indicate statistical significance.


Compared with women who delivered between the 0- and 2-hour interval, women with a second stage more than 3 hours had higher risks of operative vaginal deliveries (odds ratio = 13.27; 95% CI [9.38-18.8]), cesarean deliveries (odds ratio = 6.00; [4.06-8.86]), and maternal morbidity including third- or fourth-degree perineal lacerations, postpartum hemorrhage, and chorioamnionitis. Their neonates had higher risks of 5-minute Apgar score less than 7 (odds ratio = 3.63; 95% CI [1.77-7.43]), meconium stained amniotic fluid (odds ratio = 1.44; 95% CI [1.07-1.94]), admission to intensive care nursery (odds ratio = 2.08; 95% CI [1.15-3.77]), composite neonatal morbidity (odds ratio = 1.85; 95% CI [1.23-2.77]), and longer neonatal stay in the hospital (odds ratio = 1.67; 95% CI [1.11-2.51]).


Multiparous women with a second stage of 3 hours or greater are at increased risks for operative deliveries, peripartum morbidity, and undesirable neonatal outcomes. These outcomes should be considered in the management of multiparous women with a second stage of labor beyond 3 hours.

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