American Journal of Obstetrics & Gynecology
Volume 201, Issue 4 , Pages 357.e1-357.e7, October 2009

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

Presented in part at the 29th Annual Meeting of the Society for Maternal-Fetal Medicine, San Diego, CA, Jan. 29-31, 2009.

  • Dwight J. Rouse, MD

      Affiliations

    • Department of Obstetrics and Gynecology at the University of Alabama at Birmingham, Birmingham, AL
    • ,
  • Steven J. Weiner, MS

      Affiliations

    • Department of Obstetrics and Gynecology, The George Washington University Biostatistics Center, Washington, DC
    • ,
  • Steven L. Bloom, MD

      Affiliations

    • Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX
    • ,
  • Michael W. Varner, MD

      Affiliations

    • Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT
    • ,
  • Catherine Y. Spong, MD

      Affiliations

    • Department of Obstetrics and Gynecology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
    • ,
  • Susan M. Ramin, MD

      Affiliations

    • Department of Obstetrics and Gynecology, The University of Texas Health Science Center at Houston, Houston, TX
    • ,
  • Steve N. Caritis, MD

      Affiliations

    • Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA
    • ,
  • Alan M. Peaceman, MD

      Affiliations

    • Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL
    • ,
  • Yoram Sorokin, MD

      Affiliations

    • Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI
    • ,
  • Anthony Sciscione, DO

      Affiliations

    • Department of Obstetrics and Gynecology, Drexel University, Philadelphia, PA
    • ,
  • Marshall W. Carpenter, MD

      Affiliations

    • Department of Obstetrics and Gynecology, Brown University, Providence, RI
    • ,
  • Brian M. Mercer, MD

      Affiliations

    • Department of Obstetrics and Gynecology, Case Western Reserve University, Cleveland, OH
    • ,
  • John M. Thorp Jr, MD

      Affiliations

    • Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC
    • ,
  • Fergal D. Malone, MD

      Affiliations

    • Department of Obstetrics and Gynecology, Columbia University, New York, NY
    • ,
  • Margaret Harper, MD, MS

      Affiliations

    • Department of Obstetrics and Gynecology, Wake Forest University Health Sciences, Winston-Salem, NC
    • ,
  • Jay D. Iams, MD

      Affiliations

    • Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH
    • ,
  • Garland D. Anderson, MD

      Affiliations

    • Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX
    • ,
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network

Received 8 April 2009; received in revised form 13 July 2009; accepted 10 August 2009.

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 ≥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.

Key words: duration, nulliparous women, second stage of labor

 

 Cite this article as: Rouse DJ, Weiner SJ, Bloom SL, et al. Second-stage labor duration in nulliparous women: relationship to maternal and perinatal outcomes. Am J Obstet Gynecol 2009;201:357.e1-7.

 Reprints not available from the authors

 Supported by Grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (HD21410, HD27860, HD27869, HD27915, HD27917, HD34116, HD34136, HD34208, HD40485, HD40500, HD40512, HD40544, HD40545, HD40560, and HD36801).

PII: S0002-9378(09)00900-4

doi:10.1016/j.ajog.2009.08.003

Refers to article:

  • Cross-reference Is there an upper time limit for the management of the second stage of labor?

    Aaron B. Caughey
    American Journal of Obstetrics & Gynecology October 2009 (Vol. 201, Issue 4, Pages 337-338)

American Journal of Obstetrics & Gynecology
Volume 201, Issue 4 , Pages 357.e1-357.e7, October 2009

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