814: Nulliparous women in the second stage of labor: changes in neonatal outcomes over the past 10 years stratified by mode of delivery

2015 ◽  
Vol 212 (1) ◽  
pp. S392
Author(s):  
Joseph Fitzwater ◽  
Nana-Ama Ankumah ◽  
Sukhkamal Campbell ◽  
Joseph Biggio ◽  
John Owen ◽  
...  
Keyword(s):  
Mode Of Delivery ◽  
Neonatal Outcomes ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
The Past ◽  
Nulliparous Women

258: Nulliparous women in the second stage of labor: changes in mode of delivery over the past 10 years

2015 ◽  
Vol 212 (1) ◽  
pp. S141-S142 ◽  
Author(s):  
Joseph Fitzwater ◽  
Nana-Ama Ankumah ◽  
Sukhkamal Campbell ◽  
Joseph Biggio ◽  
John Owen ◽  
...  
Keyword(s):  
Mode Of Delivery ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
The Past ◽  
Nulliparous Women

A Randomized Control Trial of Bupivacaine and Fentanyl versus Fentanyl-only for Epidural Analgesia during the Second Stage of Labor

2015 ◽  
Vol 122 (1) ◽  
pp. 172-177 ◽  
Author(s):  
Margaret G. Craig ◽  
Erica N. Grant ◽  
Weike Tao ◽  
Donald D. McIntire ◽  
Kenneth J. Leveno
Keyword(s):  
Mode Of Delivery ◽  
Group Versus ◽  
Postnatal Period ◽  
Neonatal Outcomes ◽  
Motor Blockade ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
Nulliparous Women ◽  
Epidural Bupivacaine ◽  
Second Stage Labor

Abstract Background: The purpose of this prospective, double-blinded, parallel-arm, randomized trial was to examine the effects of epidural bupivacaine on the length of the second stage of labor in nulliparous women. Methods: The authors assessed length of second-stage labor, degree of motor blockade, mode of delivery, and visual analog scores in 310 nulliparous women with labor epidurals randomized to receive either: (1) 0.125% bupivacaine and fentanyl 2 μg/ml or (2) fentanyl 10 μg/ml alone via epidural using double blinding. Results: The median duration of the second stage was 75 min (41, 128) in the bupivacaine/fentanyl group versus 73 min (42, 120) in the fentanyl-only group (P = 0.17) with a median difference of 6.0 (95% CI, −6.0 to 18.0). Furthermore, there was no difference in degree of motor blockade, incidence of operative delivery, visual analog scores, or neonatal outcomes between the two groups. No adverse events were reported. Conclusions: Use of epidural bupivacaine/fentanyl or a fentanyl-only infusion during the second stage of labor did not affect the duration of the second stage of labor, degree of motor blockade, mode of delivery, pain relief, and maternal or neonatal outcomes. However, in the fentanyl-only infusion group, there was a fivefold increase in opioid exposure to the fetus with unknown effects on neurobehavior, an outcome not assessed beyond the immediate postnatal period in this study.

The impact of epidural analgesia on the mode of delivery in nulliparous women that attain the second stage of labor

2019 ◽  
Vol 33 (14) ◽  
pp. 2451-2458 ◽  
Author(s):  
Naama Srebnik ◽  
Omri Barkan ◽  
Misgav Rottenstreich ◽  
Alexander Ioscovich ◽  
Rivka Farkash ◽  
...  
Keyword(s):  
Epidural Analgesia ◽  
Mode Of Delivery ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
Nulliparous Women ◽  
The Impact

Angle of Progression on Ultrasound in the Second Stage of Labor and Spontaneous Vaginal Delivery

2017 ◽  
Vol 35 (04) ◽  
pp. 413-420 ◽  
Author(s):  
Caroline Rouse ◽  
David Cantonwine ◽  
Sarah Little ◽  
Thomas McElrath ◽  
Julian Robinson ◽  
...  
Keyword(s):  
Vaginal Delivery ◽  
Prospective Observational Study ◽  
Mode Of Delivery ◽  
Transperineal Ultrasound ◽  
Survival Models ◽  
Spontaneous Vaginal Delivery ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
Nulliparous Women ◽  
Angle Of Progression

Objective The objective of this study was to assess the association between the angle of progression (AoP) measured by transperineal ultrasound and mode of delivery and duration of the second stage. Study Design This is a prospective observational study of nulliparous women with a singleton gestation at term in which serial transperineal ultrasound examinations were obtained during the second stage of labor. Multivariable logistic regression and adjusted survival models were used for the analysis. Results A total of 137 patients were included in the analysis and median AoP for the study group was 153 degrees. The adjusted odds ratio (aOR) of requiring an operative delivery was 2.6 times higher for those patients who had an AoP < 153 degrees and the aOR of requiring a cesarean delivery was almost six times higher when compared with those patients who had an AoP ≥ 153 degrees (95% confidence interval [CI]: 1.0, 6.2; p = 0.04; aOR: 5.8, 95% CI: 1.2–28.3; p = 0.03, respectively). Those patients with an AoP < 153 degrees were at a higher hazard of staying pregnant longer (adjusted hazard ratio: 1.8, 95% CI: 1.2–2.8, p = 0.005). Conclusion The AoP has the potential to predict spontaneous vaginal delivery and the duration of the second stage of labor which may be useful in counseling patients and managing their labor.

scholarly journals Relationship Between Prolonged Second Stage of Labor and Short-Term Neonatal Morbidity: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 17 (21) ◽  
pp. 7762
Author(s):  
Nuria Infante-Torres ◽  
Milagros Molina-Alarcón ◽  
Angel Arias-Arias ◽  
Julián Rodríguez-Almagro ◽  
Antonio Hernández-Martínez
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Apgar Score ◽  
Neonatal Intensive Care ◽  
Neonatal Outcomes ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
Nulliparous Women ◽  
Multiparous Women

To evaluate the association between prolonged second stage of labor and the risk of adverse neonatal outcomes with a systematic review and meta-analysis. PubMed, Scopus and EMBASE were searched using the search strategy “Labor Stage, Second” AND (length OR duration OR prolonged OR abnormal OR excessive). Observational studies that examine the relationship between prolonged second stage of labor and neonatal outcomes were selected. Prolonged second stage of labor was defined as 4 h or more in nulliparous women and 3 h or more in multiparous women. The main neonatal outcomes were 5 min Apgar score <7, admission to the Neonatal Intensive Care Unit, neonatal sepsis and neonatal death. Data collection and quality assessment were carried out independently by the three reviewers. Twelve studies were selected including 266,479 women. In nulliparous women, a second stage duration greater than 4 h increased the risk of 5 min Apgar score <7, admission to the Neonatal Intensive Care Unit and neonatal sepsis and intubation. In multiparous women, a second stage of labor greater than 3 h was related to 5 min Apgar score <7, admission to the Neonatal Intensive Care Unit, meconium staining and composite neonatal morbidity. Prolonged second stage of labor increased the risk of 5 min Apgar score <7 and admission to the Neonatal Intensive Care Unit in nulliparous and multiparous women, without increasing the risk of neonatal death. This review demonstrates that prolonged second stage of labor increases the risk of neonatal complications in nulliparous and multiparous women.

Prolonged interpregnancy interval: how does it impact the length of second stage of labor?

2020 ◽  
Vol 48 (8) ◽  
pp. 811-818
Author(s):  
Nicole B. Kurata ◽  
Keith K. Ogasawara ◽  
Kathryn L. Pedula ◽  
William A. Goh
Keyword(s):  
Perinatal Outcomes ◽  
Kaiser Permanente ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
Labor Duration ◽  
Nulliparous Women ◽  
Multiparous Women ◽  
Comparison Groups ◽  
Maternal And Neonatal Outcomes ◽  
Interpregnancy Intervals

AbstractObjectivesShort interpregnancy intervals (IPI) have been linked to multiple adverse maternal and neonatal outcomes, but less is known about prolonged IPI, including its relationship with labor progression. The objective of the study was to investigate whether prolonged IPIs are associated with longer second stages of labor.MethodsA perinatal database from Kaiser Permanente Hawaii was used to identify 442 women with a prolonged IPI ≥60 months. Four hundred forty two nulliparous and 442 multiparous women with an IPI 18–59 months were selected as comparison groups. The primary outcome was second stage of labor duration. Perinatal outcomes were compared between these groups.ResultsThe median (IQR) second stage of labor duration was 76 (38–141) min in nulliparous women, 15 (9–28) min in multiparous women, and 18 (10–38) min in women with a prolonged IPI (p<0.0001). Pairwise comparisons revealed significantly different second stage duration in the nulliparous group compared to both the multiparous and prolonged IPI groups, but no difference between the multiparous and prolonged IPI groups. There was a significant association with the length of the IPI; median duration 30 (12–61) min for IPI ≥120 months vs. 15 (9–27) min for IPI 18–59 months and 16 (9–31) min for IPI 60–119 months (p=0.0014).ConclusionsThe second stage of labor did not differ in women with a prolonged IPI compared to normal multiparous women. Women with an IPI ≥120 months had a significantly longer second stage vs. those with a shorter IPI. These findings provide a better understanding of labor progression in pregnancies with a prolonged IPI.

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