Defining the upper limit of the second stage of labor in nulliparous patients.

Published on Aug 1, 2019
· DOI :10.1016/J.AJOGMF.2019.100029
Catherine Finnegan1
Estimated H-index: 1
(RCSI: Royal College of Surgeons in Ireland),
Naomi Burke5
Estimated H-index: 5
(RCSI: Royal College of Surgeons in Ireland)
+ 15 AuthorsFergal D. Malone62
Estimated H-index: 62
(RCSI: Royal College of Surgeons in Ireland)
Abstract Background Increased duration of second stage of labor provides clinical challenges in decision- making regarding the optimal mode of delivery that minimises maternal and neonatal morbidity. Objective In a large cohort of uncomplicated nulliparous singleton cephalic labors, we sought to examine the effect of increasing duration of second stage on delivery and perinatal outcome. Design The Genesis Study recruited 2,336 nulliparous patients with vertex presentation in a prospective double-blinded study to examine prenatal and intra-partum predictors of delivery. Metrics included maternal demographics, duration of second stage, mode of delivery, and associated maternal and neonatal outcomes. Indicators of morbidity included 3rd or 4th degree tear, postpartum hemorrhage (PPH), NICU admission, low Apgar scores, cord pH Results Of 2,336 recruited nulliparous participants, 1,872 reached the second stage of labor and had complete data for analysis. Increased maternal age (p=0.02), and birthweight ( 3 hours (p 3hours (p 3 hours (p 3hours. The maximum rate of birth injury was 6.5% at 2-3 hours (p Conclusion In a prospective cohort of nulliparous pregnancies, increasing duration of second stage of labor was associated with increased rates of operative vaginal and cesarean delivery. While almost 90% of term nulliparous women with a 2nd stage of labour exceeding 3 hours will succeed in achieving a vaginal birth, this success comes at a maternal morbidity cost, with a 10% risk of severe perineal injury and an increasing rate of significant neonatal injury.
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Abstract null null Objective null In the prospective multicenter Genesis study, we developed a prediction model for Cesarean delivery (CD) in term nulliparous women. The objective of this secondary analysis was to determine whether the Genesis model has the potential to predict maternal and neonatal morbidity associated with vaginal delivery. null null null Study Design: null The national prospective Genesis trial recruited 2,336 nulliparous women with a vertex presentation between 39+0- and 40+...