Perinatal Outcomes with Longer Second Stage of Labor: A Risk Analysis Comparing Expectant Management to Operative Intervention
| Autor: | Sara Foppe Jennings, Elizabeth B. Ausbeck, Christina T. Blanchard, Lorie M. Harper, Alan T.N. Tita, Meredith Gray, Macie L. Champion |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Risk analysis medicine.medical_specialty Chorioamnionitis Risk Assessment law.invention Young Adult 03 medical and health sciences 0302 clinical medicine Labor Stage Second Pregnancy law Intervention (counseling) medicine Humans Labor Induced 030212 general & internal medicine Stage (cooking) Watchful Waiting Retrospective Studies 030219 obstetrics & reproductive medicine Cesarean Section business.industry Obstetrics Postpartum Hemorrhage Infant Newborn Obstetrics and Gynecology Odds ratio medicine.disease Intensive care unit Confidence interval Obstetric Labor Complications Logistic Models Pediatrics Perinatology and Child Health Cohort Alabama Female business |
| Zdroj: | American Journal of Perinatology. 37:1201-1207 |
| ISSN: | 1098-8785 0735-1631 |
| Popis: | Objective The aim of this study is to assess the impact of a prolonged second stage of labor on maternal and neonatal outcomes by comparing women who had expectant management versus operative intervention beyond specified timeframes in the second stage of labor. Study Design Retrospective cohort including live singletons at ≥36 weeks who reached the second stage of labor. Expectant management (second stage >3, 2, 2, and 1 hour in nulliparas with an epidural, nulliparas without an epidural, multiparas with an epidural, and multiparas without an epidural, respectively) was compared with those who had an operative delivery (vaginal or cesarean) prior to these timeframes. The primary maternal outcome was a composite of postpartum hemorrhage, chorioamnionitis, operative complications, postpartum infections, and intensive care unit admission. The primary neonatal outcome was a composite of cord blood acidemia, 5-minute Apgar's score 1 day. Results Among 218 women, 115 (52.8%) had expectant management. Expectant management was associated with a significantly increased risk of the maternal composite (adjusted odds ratio [aOR]: 1.99, 95% confidence interval [CI]: 1.09–3.64) but not the neonatal composite (aOR: 1.54, 95% CI: 0.71–3.35). Conclusion Expectant management of a prolonged second stage was associated with a higher rate of adverse maternal outcomes, but the rate of adverse neonatal outcomes was not significantly increased. |
| Databáze: | OpenAIRE |
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