Maternal and perinatal outcomes of prolonged second stage of labour: a historical cohort study of over 51,000 women

Catriona Young; Sohinee Bhattacharya; Andrea Woolner; Amy Ingram; Nicole Smith; Edwin-Amalraj Raja; Mairead Black

doi:10.1186/s12884-023-05733-z

Maternal and perinatal outcomes of prolonged second stage of labour: a historical cohort study of over 51,000 women

Catriona Young^* (Corresponding Author), Sohinee Bhattacharya, Andrea Woolner, Amy Ingram, Nicole Smith, Edwin-Amalraj Raja, Mairead Black

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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Abstract

BACKGROUND: Prolonged second stage of labour has been associated with adverse maternal and perinatal outcomes. The maximum length of the second stage from full dilatation to birth of the baby remains controversial. Our aim was to determine whether extending second stage of labour was associated with adverse maternal and perinatal outcomes.

METHODS: A retrospective cohort study was conducted using routinely collected hospital data from 51592 births in Aberdeen Maternity Hospital between 2000 and 2016. The hospital followed the local guidance of allowing second stage of labour to extend by an hour compared to national guidelines since 2008 (nulliparous and parous). The increasing duration of second stage of labour was the exposure. Baseline characteristics, maternal and perinatal outcomes were compared between women who had a second stage labour of (a) ≤ 3 h and (b) > 3 h duration for nulliparous women; and (a) ≤ 2 h or (b) > 2 h for parous women. An additional model was run that treated the duration of second stage of labour as a continuous variable (measured in hours). All the adjusted models accounted for: age, BMI, smoking status, deprivation category, induced birth, epidural, oxytocin, gestational age, baby birthweight, mode of birth and parity (only for the final model).

RESULTS: Each hourly increase in the second stage of labour was associated with an increased risk of obstetric anal sphincter injury (aOR 1.21 95% CI 1.16,1.25), having an episiotomy (aOR 1.48 95% CI 1.45, 1.52) and postpartum haemorrhage (aOR 1.27 95% CI 1.25, 1.30). The rates of caesarean and forceps delivery also increased when second stage duration increased (aOR 2.60 95% CI 2.50, 2.70, and aOR 2.44 95% CI 2.38, 2.51, respectively.) Overall adverse perinatal outcomes were not found to change significantly with duration of second stage on multivariate analysis.

CONCLUSIONS: As the duration of second stage of labour increased each hour, the risk of obstetric anal sphincter injuries, episiotomies and PPH increases significantly. Women were over 2 times more likely to have a forceps or caesarean birth. The association between adverse perinatal outcomes and the duration of second stage of labour was less convincing in this study.

Original language	English
Article number	467
Number of pages	10
Journal	BMC Pregnancy and Childbirth
Volume	23
Issue number	1
Early online date	22 Jun 2023
DOIs	https://doi.org/10.1186/s12884-023-05733-z
Publication status	Published - 22 Jun 2023

Bibliographical note

Funding
This work was supported by Vacation Scholarship from Medical Research Scotland (No. Vac-1509–2019). The funders had no involvement in the study design, data collection and analysis, interpretation of data and preparation of the manuscript.

Keywords

Second stage
Birth
Prolonged labour

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Cite this

@article{aebabe6ed94f4b75b9c1c77f847a4077,

title = "Maternal and perinatal outcomes of prolonged second stage of labour: a historical cohort study of over 51,000 women",

abstract = "BACKGROUND: Prolonged second stage of labour has been associated with adverse maternal and perinatal outcomes. The maximum length of the second stage from full dilatation to birth of the baby remains controversial. Our aim was to determine whether extending second stage of labour was associated with adverse maternal and perinatal outcomes.METHODS: A retrospective cohort study was conducted using routinely collected hospital data from 51592 births in Aberdeen Maternity Hospital between 2000 and 2016. The hospital followed the local guidance of allowing second stage of labour to extend by an hour compared to national guidelines since 2008 (nulliparous and parous). The increasing duration of second stage of labour was the exposure. Baseline characteristics, maternal and perinatal outcomes were compared between women who had a second stage labour of (a) ≤ 3 h and (b) > 3 h duration for nulliparous women; and (a) ≤ 2 h or (b) > 2 h for parous women. An additional model was run that treated the duration of second stage of labour as a continuous variable (measured in hours). All the adjusted models accounted for: age, BMI, smoking status, deprivation category, induced birth, epidural, oxytocin, gestational age, baby birthweight, mode of birth and parity (only for the final model).RESULTS: Each hourly increase in the second stage of labour was associated with an increased risk of obstetric anal sphincter injury (aOR 1.21 95% CI 1.16,1.25), having an episiotomy (aOR 1.48 95% CI 1.45, 1.52) and postpartum haemorrhage (aOR 1.27 95% CI 1.25, 1.30). The rates of caesarean and forceps delivery also increased when second stage duration increased (aOR 2.60 95% CI 2.50, 2.70, and aOR 2.44 95% CI 2.38, 2.51, respectively.) Overall adverse perinatal outcomes were not found to change significantly with duration of second stage on multivariate analysis.CONCLUSIONS: As the duration of second stage of labour increased each hour, the risk of obstetric anal sphincter injuries, episiotomies and PPH increases significantly. Women were over 2 times more likely to have a forceps or caesarean birth. The association between adverse perinatal outcomes and the duration of second stage of labour was less convincing in this study.",

keywords = "Second stage, Birth, Prolonged labour",

author = "Catriona Young and Sohinee Bhattacharya and Andrea Woolner and Amy Ingram and Nicole Smith and Edwin-Amalraj Raja and Mairead Black",

note = "Funding This work was supported by Vacation Scholarship from Medical Research Scotland (No. Vac-1509–2019). The funders had no involvement in the study design, data collection and analysis, interpretation of data and preparation of the manuscript.",

year = "2023",

month = jun,

day = "22",

doi = "10.1186/s12884-023-05733-z",

language = "English",

volume = "23",

journal = "BMC Pregnancy and Childbirth",

issn = "1471-2393",

publisher = "BioMed Central",

number = "1",

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TY - JOUR

T1 - Maternal and perinatal outcomes of prolonged second stage of labour

T2 - a historical cohort study of over 51,000 women

AU - Young, Catriona

AU - Bhattacharya, Sohinee

AU - Woolner, Andrea

AU - Ingram, Amy

AU - Smith, Nicole

AU - Raja, Edwin-Amalraj

AU - Black, Mairead

N1 - Funding This work was supported by Vacation Scholarship from Medical Research Scotland (No. Vac-1509–2019). The funders had no involvement in the study design, data collection and analysis, interpretation of data and preparation of the manuscript.

PY - 2023/6/22

Y1 - 2023/6/22

N2 - BACKGROUND: Prolonged second stage of labour has been associated with adverse maternal and perinatal outcomes. The maximum length of the second stage from full dilatation to birth of the baby remains controversial. Our aim was to determine whether extending second stage of labour was associated with adverse maternal and perinatal outcomes.METHODS: A retrospective cohort study was conducted using routinely collected hospital data from 51592 births in Aberdeen Maternity Hospital between 2000 and 2016. The hospital followed the local guidance of allowing second stage of labour to extend by an hour compared to national guidelines since 2008 (nulliparous and parous). The increasing duration of second stage of labour was the exposure. Baseline characteristics, maternal and perinatal outcomes were compared between women who had a second stage labour of (a) ≤ 3 h and (b) > 3 h duration for nulliparous women; and (a) ≤ 2 h or (b) > 2 h for parous women. An additional model was run that treated the duration of second stage of labour as a continuous variable (measured in hours). All the adjusted models accounted for: age, BMI, smoking status, deprivation category, induced birth, epidural, oxytocin, gestational age, baby birthweight, mode of birth and parity (only for the final model).RESULTS: Each hourly increase in the second stage of labour was associated with an increased risk of obstetric anal sphincter injury (aOR 1.21 95% CI 1.16,1.25), having an episiotomy (aOR 1.48 95% CI 1.45, 1.52) and postpartum haemorrhage (aOR 1.27 95% CI 1.25, 1.30). The rates of caesarean and forceps delivery also increased when second stage duration increased (aOR 2.60 95% CI 2.50, 2.70, and aOR 2.44 95% CI 2.38, 2.51, respectively.) Overall adverse perinatal outcomes were not found to change significantly with duration of second stage on multivariate analysis.CONCLUSIONS: As the duration of second stage of labour increased each hour, the risk of obstetric anal sphincter injuries, episiotomies and PPH increases significantly. Women were over 2 times more likely to have a forceps or caesarean birth. The association between adverse perinatal outcomes and the duration of second stage of labour was less convincing in this study.

AB - BACKGROUND: Prolonged second stage of labour has been associated with adverse maternal and perinatal outcomes. The maximum length of the second stage from full dilatation to birth of the baby remains controversial. Our aim was to determine whether extending second stage of labour was associated with adverse maternal and perinatal outcomes.METHODS: A retrospective cohort study was conducted using routinely collected hospital data from 51592 births in Aberdeen Maternity Hospital between 2000 and 2016. The hospital followed the local guidance of allowing second stage of labour to extend by an hour compared to national guidelines since 2008 (nulliparous and parous). The increasing duration of second stage of labour was the exposure. Baseline characteristics, maternal and perinatal outcomes were compared between women who had a second stage labour of (a) ≤ 3 h and (b) > 3 h duration for nulliparous women; and (a) ≤ 2 h or (b) > 2 h for parous women. An additional model was run that treated the duration of second stage of labour as a continuous variable (measured in hours). All the adjusted models accounted for: age, BMI, smoking status, deprivation category, induced birth, epidural, oxytocin, gestational age, baby birthweight, mode of birth and parity (only for the final model).RESULTS: Each hourly increase in the second stage of labour was associated with an increased risk of obstetric anal sphincter injury (aOR 1.21 95% CI 1.16,1.25), having an episiotomy (aOR 1.48 95% CI 1.45, 1.52) and postpartum haemorrhage (aOR 1.27 95% CI 1.25, 1.30). The rates of caesarean and forceps delivery also increased when second stage duration increased (aOR 2.60 95% CI 2.50, 2.70, and aOR 2.44 95% CI 2.38, 2.51, respectively.) Overall adverse perinatal outcomes were not found to change significantly with duration of second stage on multivariate analysis.CONCLUSIONS: As the duration of second stage of labour increased each hour, the risk of obstetric anal sphincter injuries, episiotomies and PPH increases significantly. Women were over 2 times more likely to have a forceps or caesarean birth. The association between adverse perinatal outcomes and the duration of second stage of labour was less convincing in this study.

KW - Second stage

KW - Birth

KW - Prolonged labour

U2 - 10.1186/s12884-023-05733-z

DO - 10.1186/s12884-023-05733-z

M3 - Article

C2 - 37349683

SN - 1471-2393

VL - 23

JO - BMC Pregnancy and Childbirth

JF - BMC Pregnancy and Childbirth

IS - 1

M1 - 467

ER -

Maternal and perinatal outcomes of prolonged second stage of labour: a historical cohort study of over 51,000 women

Abstract

Bibliographical note

Keywords

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