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Second-stage Labor: How Long is Too Long?

Leveno, Kenneth J. MD; Nelson, David B. MD; McIntire, Donald D. PhD

Obstetric Anesthesia Digest: March 2017 - Volume 37 - Issue 1 - p 18
doi: 10.1097/
Epidemiologic Reports Surveys

(Am J Obstet Gynecol. 2016;214(4):484–489)

Data available show that the rates of cesarean delivery are increasing continually (reaching a record high of 32.9% in the United States in 2009), especially in the management of first and second stages of labor. Hence there is an increased scrutiny of the management of labor. The Society for Maternal-Fetal Medicine, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the American Congress of Obstetricians and Gynecologists convened a workshop to address this issue of rising cesarean delivery rates. One of their recommendations was that the accepted upper limit of the second stage of labor should be increased to ≥4 hours in nulliparous women with epidural analgesia and to >3 hours in parous women with epidural analgesia. These recommendations were presented in a document entitled “Safe Prevention of the Primary Cesarean Delivery,” which was the inaugural publication in the Obstetric Care Consensus series.

Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX

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