BJOG : an international journal of obstetrics and gynaecology · 2022
Duration of the second stage of labour and risk of subsequent spontaneous preterm birth.
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Kleinstern Geffen, Zigron Roy, Porat Shay, Rosenbloom Joshua I, Rottenstreich Misgav, Sompolinsky Yishay, Rottenstreich Amihai
Аннотация
OBJECTIVES: To determine the risk of spontaneous preterm birth (sPTB) associated with the length of second stage of labour in the first term delivery.
DESIGN: Retrospective cohort study.
SETTING: University hospital.
POPULATION: Women with first two consecutive singleton births and the first birth at term. Those who did not reach the second stage of labour in the first delivery were excluded.
METHODS: Charts from 2007 to 2019 were reviewed.
MAIN OUTCOME MEASURES: Rate of sPTB (<37 weeks of gestation) in the second delivery.
RESULTS: Of 13 958 women who met study inclusion criteria, 1464 (10.5%) parturients had a prolonged second stage (≥180 min) in their first term delivery. The rate of sPTB in the second delivery was similar in those with and without a prolonged second stage in first delivery (2.8% versus 2.8%; adjusted odds ratio [aOR] 1.35, 95% CI 0.96-1.90). After adjustment for mode of delivery, prolonged second stage was also not associated with subsequent sPTB in those who delivered by spontaneous and operative vaginal delivery. Those delivered by second-stage caesarean section in the first delivery had a higher risk of sPTB in the second delivery (25/526, 4.8%; aOR 2.66, 95% CI 1.71-4.12; p < 0.001), with a more pronounced risk in those with second-stage caesarean following a prolonged second stage of labour (15/259, 5.8%; aOR 3.40, 95% CI 1.94-5.94; p < 0.001).
CONCLUSION: Second-stage duration in a first term vaginal delivery is not associated with subsequent sPTB. The risk of sPTB is increased following second-stage caesarean section, particularly if performed after a prolonged second stage.
TWEETABLE ABSTRACT: Second-stage caesarean delivery, particularly after prolonged second stage, increases the risk of preterm birth.
DESIGN: Retrospective cohort study.
SETTING: University hospital.
POPULATION: Women with first two consecutive singleton births and the first birth at term. Those who did not reach the second stage of labour in the first delivery were excluded.
METHODS: Charts from 2007 to 2019 were reviewed.
MAIN OUTCOME MEASURES: Rate of sPTB (<37 weeks of gestation) in the second delivery.
RESULTS: Of 13 958 women who met study inclusion criteria, 1464 (10.5%) parturients had a prolonged second stage (≥180 min) in their first term delivery. The rate of sPTB in the second delivery was similar in those with and without a prolonged second stage in first delivery (2.8% versus 2.8%; adjusted odds ratio [aOR] 1.35, 95% CI 0.96-1.90). After adjustment for mode of delivery, prolonged second stage was also not associated with subsequent sPTB in those who delivered by spontaneous and operative vaginal delivery. Those delivered by second-stage caesarean section in the first delivery had a higher risk of sPTB in the second delivery (25/526, 4.8%; aOR 2.66, 95% CI 1.71-4.12; p < 0.001), with a more pronounced risk in those with second-stage caesarean following a prolonged second stage of labour (15/259, 5.8%; aOR 3.40, 95% CI 1.94-5.94; p < 0.001).
CONCLUSION: Second-stage duration in a first term vaginal delivery is not associated with subsequent sPTB. The risk of sPTB is increased following second-stage caesarean section, particularly if performed after a prolonged second stage.
TWEETABLE ABSTRACT: Second-stage caesarean delivery, particularly after prolonged second stage, increases the risk of preterm birth.