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To determine whether induction of labor is associated with prolongation of the 2nd stage of labor.
A retrospective cohort study of all women with singleton pregnancies who attempted vaginal delivery and progressed to the 2nd stage of labor in a university-affiliated tertiary hospital (Jul-2013 to Mar-2015). The duration of the 2nd stage of labor and the rate of prolonged 2nd stage was compared between women who underwent Prostaglandin E2 (PG) induction of labor (study group) to those with spontaneous onset of labor (control group). Prolonged 2nd stage was defined as 2nd stage duration >2 or >1 hour in multiparous with or without epidural anesthesia, respectively, and >3 or >2 hours in nulliparous with or without epidural anesthesia, respectively. Women who underwent operative deliveries (vaginal or cesarean) other than for the indication of arrest of descent were excluded.
1) Of the 15,564 deliveries during the study period, 11,171 (71.7%) women met inclusion criteria, of them, 1,142 (12.7%) underwent PG induction and 9,749 (87.3%) had spontaneous onset of labor.
2) There were higher rates of nulliparous and pregnancy related complications (hypertensive disorders, diabetes mellitus and IUGR) in the study group compared to the controls (Table).
3) In the study group, there was higher rates of epidural anesthesia (75.8 vs. 64.7%, P<0.001), POP position (2.3 vs. 1.4%, P=0.008) and oxytocin augmentation (53.9% vs. 40.0%, P<0.001) and lower rate of spontaneous deliveries (91.7 vs. 95.9%, P<0.001) compared to the controls.
4) The duration of the 2nd stage and the rate of prolonged 2nd stage were higher in the study group only for nulliparous women (108.6±3.0 vs. 96.6±1.2 minutes, P<0.001 and 10.2 vs. 5.0%, P<0.001, respectively).
5) In multivariable analysis, induction of labor was not associated with prolonged 2nd stage neither in nulliparous (0.58 (0.39-1.68), P=0.58) nor in multiparous (0.23 (0.30-1.86), P=0.17).
Induction of labor with PGE2 is not associated with prolonged 2nd stage of labor.