Extending the Time Limit of the Second Stage of Labour Versus Delivering on Time Operatively: A Retrospective Cohort Study

Objectives

To analyze the effect of extending the second stage on maternal outcomes compared to not exceeding the time at the expense of 100% operative delivery.

Methods

A retrospective study was conducted in a university teaching hospital on data between 2018 and 2020. Nulliparous with a singleton, viable, term fetus in a cephalic presentation at the second stage was incorporated. Study cohort was partitioned into 3 groups: group 1, nulliparous who delivered operatively (100%) by cesarean delivery or vacuum extraction within 2 hours (or 3 hours with epidural); group 2, nulliparous who proceeded with a trial of labour past 2 hours (or 3 hours with epidural); group 3, nulliparous who had a spontaneous vaginal delivery within 2 hours (or 3 hours with epidural). The primary outcome was a composite of maternal morbidities that included at least 1 of the followings: postpartum hemorrhage, infection (any), fever ≥38°C, abdominal organs injury, anal sphincter injury, relaparotomy, and maternal intensive care unit admission.

Results

Overall, 1007 nulliparous were eligible, 215, 252, and 540 in groups 1, 2, and 3 respectively. Incidence of the primary outcome was 31 (14.4%), 62 (24.6%), and 73 (13.5%) in groups 1, 2, and 3 respectively (P = 0.001). After adjusting for demographic and obstetric variables, the primary outcome rate remained significantly greater in group 2 compared to group 1 (adjusted OR 1.86; 95% CI 1.10–3.15, P = 0.021) and group 3 (adjusted OR 1.62; 95% CI 1.05–2.50, P = 0.029).

Conclusions

In nulliparous women, extending the second stage >2 hours (or >3 hours with epidural) was associated with increased maternal morbidity compared to a shortened second stage and 100% operative delivery.