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Effects of Labor Stage Duration on Maternal and Perinatal Outcomes: A Retrospective Cohort Study
Abstract Number: F3D-534
Abstract Type: Original Research
The permitted durations of first and second stages of labor was increased in the American College of Obstetricians and Gynecologists (ACOG) published 2014 consensus. Recent studies showed increased incidence of adverse maternal and neonatal outcomes when second stage labor duration prolonged to greater than 3 hours with epidural analgesia. We performed a retrospective cohort study on the effects of labor stages on maternal and perinatal outcomes.
Retrospective analysis of medical record data from the Brigham and Women’s Hospital during the year of 2017 was performed. Cephalic, term, singleton parturients with complete labor records were included, who planned for vaginal delivery. Adverse outcomes were defined if the parturient had operative vaginal delivery (OVD), intrapartum cesarean delivery (ICD), shoulder dystocia, postpartum hemorrhage (≥1000ml), 3rd or 4th degree perineal laceration, episiotomy, venous thromboembolism (VET), chorioamnionitis, maternal length of hospital stay ≥ 90th percentile (LOH90%), perinatal death, transfer to neonatal intensive care unit (NICU), Apgar score ≤ 7 at 1 min or 5 min. We defined the term total stage as the total of 1st and 2nd stages of labor durations.
Of 1617 parturients included, spontaneous vaginal delivery (SVD) succeeded in 1434 (88.7%). OVD were 118 (7.3%); ICD were 65 (4.0%). The risk of OVD, hemorrhage, lacerations, LOH90%, NICU transfer, chorioamnionitis, episiotomy, Apgar ≤ 7 (5 min), shoulder dystocia increased with the prolonged first stage (P < 0.05). The risk of OVD, ICD, hemorrhage, lacerations, VET, LOH90%, NICU transfer, chorioamnionitis, episiotomy, Apgar ≤7 at both 1 min and 5 min increased with the prolonged 2nd stage duration and total stage duration of labor. (P < 0.05) (Figure 1)
Grantz et al found that the rates of spontaneous vaginal delivery without serious morbidity decreased with increasing 2nd stage duration. Our study further demonstrated that prolonged labor stages, either 1st stage, 2nd stage or total stages were related to maternal and perinatal adverse outcomes. We advocate for early intervention to reduce these unnecessary complications. Large prospective cohort studies should be performed to confirm these effects of labor stage durations.
2. Cohen SM, et al. Ultrasound Obstet Gynecol 2017
3. Grantz, KL, et al. Obstet Gynecol 2018