Second-Stage Duration and Outcomes Among Women Who Labored After a Prior Cesarean Delivery

Abstract Objective To estimate second stage duration and its effects on labor outcomes in obese versus nonobese nulliparous women. Study Design This was a secondary analysis of a cohort of nulliparous women who presented for labor at term and reached complete cervical dilation. Adjusted relative risks (aRR) were used to estimate the association between obesity and second stage characteristics, composite neonatal morbidity, and composite maternal morbidity. Effect modification of prolonged second stage on the association between obesity and morbidity was assessed by including an interaction term in the regression model. Results Compared with nonobese, obese women were more likely to have a prolonged second stage (aRR: 1.48, 95% CI: 1.18–1.85 for ≥3 hours; aRR: 1.65, 95% CI: 1.18–2.30 for ≥4 hours). Obesity was associated with a higher rate of second stage cesarean (aRR: 1.78, 95% CI: 1.34–2.34) and cesarean delivery for fetal distress (aRR: 2.67, 95% CI: 1.18–3.58). Obesity was also associated with increased rates of neonatal (aRR: 1.38, 95% CI: 1.05–1.80), but not maternal morbidity (aRR: 1.06, 95% CI: 0.90–1.25). Neonatal morbidity risk was not modified by prolonged second stage. Conclusion Obesity is associated with increased risk of neonatal morbidity, which is not modified by prolonged second stage of labor.

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962: Admission factors vs. intrapartum factors: What matters more in predicting a second stage cesarean delivery?

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2018.11.986 ◽

2019 ◽

Vol 220 (1) ◽

pp. S619

Author(s):

Heather N. Lopez ◽

Nandini Raghuraman ◽

Molly Stout ◽

Julia Lopez ◽

George Macones ◽

...

Keyword(s):

Cesarean Delivery ◽

Second Stage ◽

Intrapartum Factors ◽

What Matters

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Risk of First-Stage and Second-Stage Cesarean Delivery by Maternal Body Mass Index Among Nulliparous Women in Labor at Term

Obstetrics and Gynecology ◽

10.1097/aog.0b013e318217922a ◽

2011 ◽

Vol 117 (6) ◽

pp. 1315-1322 ◽

Cited By ~ 45

Author(s):

Elaine M. Fyfe ◽

Ngaire H. Anderson ◽

Robyn A. North ◽

Eliza H. Y. Chan ◽

Rennae S. Taylor ◽

...

Keyword(s):

Body Mass Index ◽

Cesarean Delivery ◽

Body Mass ◽

Maternal Body Mass Index ◽

Maternal Body ◽

Second Stage ◽

Nulliparous Women

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Lumbar Sympathetic Blocks Speed Early and Second Stage Induced Labor in Nulliparous Women

Anesthesiology ◽

10.1097/00000542-199904000-00017 ◽

1999 ◽

Vol 90 (4) ◽

pp. 1039-1046 ◽

Cited By ~ 21

Author(s):

Barbara L. Leighton ◽

Stephen H. Halpern ◽

Donna B. Wilson

Keyword(s):

Epidural Analgesia ◽

Cesarean Delivery ◽

Delivery Mode ◽

Sympathetic Block ◽

Cervical Dilation ◽

Induced Labor ◽

Second Stage ◽

Vaginal Deliveries ◽

Epidural Catheters ◽

Sympathetic Blocks

Background Rapid cervical dilation reportedly accompanies lumbar sympathetic blockade, whereas epidural analgesia is associated with slow labor. The authors compared the effects of initial lumbar sympathetic block with those of epidural analgesia on labor speed and delivery mode in this pilot study. Methods At a hospital not practicing active labor management, full-term nulliparous patients whose labors were induced randomly received initial lumbar sympathetic block or epidural analgesia. The latter patients received 10 ml bupivacaine, 0.125%; 50 microg fentanyl; and 100 microg epinephrine epidurally and sham lumbar sympathetic blocks. Patients to have lumbar sympathetic blocks received 10 ml bupivacaine, 0.5%; 25 microg fentanyl; and 50 microg epinephrine bilaterally and epidural catheters. Subsequently, all patients received epidural analgesia. Results Cervical dilation occurred more quickly (57 vs. 120 min/cm cervical dilation; P = 0.05) during the first 2 h of analgesia in patients having lumbar sympathetic blocks (n = 17) than in patients having epidurals (n = 19). The second stage of labor was briefer in patients having lumbar sympathetic blocks than in those having epidurals (105 vs. 270 min; P < 0.05). Nine patients having lumbar sympathetic block and seven having epidurals delivered spontaneously, whereas seven patients having lumbar sympathetic block and seven having epidurals had instrument-assisted vaginal deliveries. Cesarean delivery for fetal bradycardia occurred in one patient having lumbar sympathetic block. Cesarean delivery for dystocia occurred in five patients having epidurals compared with no patient having lumbar sympathetic block (P = not significant). Visual analog pain scores differed only at 60 min after block. Conclusions Nulliparous parturients having induced labor and receiving initial lumbar sympathetic blocks had faster cervical dilation during the first 2 h of analgesia, shorter second-stage labors, and a trend toward a lower dystocia cesarean delivery rate than did patients having epidural analgesia. The effects of lumbar sympathetic block on labor need to be determined in other patient groups. These results may help define the tocodynamic effects of regional labor analgesia.

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