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Reassessing the Duration of the Second Stage of Labor in Relation to Maternal and Neonatal Morbidity

Grantz, K.L.; Sundaram, R.; Ma, L.; Hinkle, S.; Berghella, V.; Hoffman, M.K.; Reddy, U.M.

Obstetric Anesthesia Digest: June 2018 - Volume 38 - Issue 2 - p 71
doi: 10.1097/01.aoa.0000532263.77010.0d
Epidemiologic Reports, Surveys

(Obstet Gynecol. 2018;131(2):345–353)

Prolonged second stage of labor is associated with an increased risk of postpartum hemorrhage, maternal febrile morbidity, infection, perineal trauma, and neonatal morbidities. Previously, the Society for Maternal-Fetal Medicine and American College of Obstetricians and Gynecologists in an effort to reduce an initial cesarean section in patients receiving epidural analgesia, recommended that second-stage arrest be redefined by the addition of 1 hour: 4 versus 3 hours for nulliparous women with an epidural, and 3 versus 2 hours for multiparous women with an epidural. In the present study, the authors calculated the likelihood of vaginal birth without serious maternal or neonatal morbidity or mortality compared with birth with morbidity or mortality, so as to better inform clinical decision-making.

Epidemiology Branch and the Biostatistics and Bioinformatics Branch, Division of Intramural Population Health Research, and the Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD

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