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Obstet Gynecol Surv. 2016 Nov;71(11):667-674. doi: 10.1097/OGX.0000000000000368.

Prolonged Second Stage: What Is the Optimal Length?

Author information

1
Assistant Professor, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, George Washington University School of Medicine and Heath Sciences, Washington, DC.
2
Professor and Division Director, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA.

Abstract

Importance:

Prolonged second stage of labor is a clinical dilemma in which controversy exists on whether extending labor in nulliparous women with epidural anesthesia decreases the incidence of cesarean delivery without increasing maternal or neonatal risks.

Objective:

This narrative review was conducted to assess the current literature on management of and risks associated with a prolonged second stage in nulliparous women with epidurals.

Evidence Acquisition:

A review of the current literature was performed to evaluate the incidence of cesarean delivery and the maternal and neonatal outcomes.

Results:

A total of 11.5% of nulliparous women with epidurals have a prolonged second stage; 80.2% of these women deliver vaginally. There is 1 randomized controlled trial on prolonged second stage in nulliparous women with epidurals. In this study, extending the second stage beyond current guidelines decreased the incidence of cesarean delivery by 55% and did not increase maternal or neonatal risks. Most patients (75.6%) with a prolonged second stage delivered by 5 hours and had a vaginal delivery (80.5%). Women with a fetus in occiput anterior position or who presented in spontaneous labor had decreased risk of cesarean delivery (by 83% and 89%, respectively). Maternal risks include postpartum hemorrhage, chorioamnionitis, and third- and fourth-degree lacerations. Neonatal risks may have a small absolute increase.

Conclusions and Relevance:

The change of a vaginal delivery is high (over 80%) beyond 3 hours in the second stage. Maternal and neonatal risks need to be further explored by larger, better-designed retrospective reviews or trials.

PMID:
27901551
DOI:
10.1097/OGX.0000000000000368
[Indexed for MEDLINE]

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