Perinatal Outcome in 1515 Cases of Prolonged Second Stage of Labour in Nulliparous Women.

OBJECTIVE

To examine perinatal outcomes among nulliparous women with a second stage of labour lasting more than three hours.

METHODS

We conducted a retrospective review of all nulliparous women over a 14-year period who had a term, live, singleton, cephalic fetus ≥ 2500 g and who had a second stage of labour lasting at least three hours. Outcome measures included five-minute Apgar score < 7, cord arterial pH < 7.10, admission to the NICU, neonatal seizures, and neonatal death. Rates of serious long-term neurologic morbidity were also analyzed. Outcomes were compared with those of a similar cohort of women who delivered after less than three hours in the second stage.

RESULTS

During the study period, 1515 women met the inclusion criteria. The majority of women (67%) delivered vaginally, after up to 10 hours in the second stage of labour. The overall rate of Caesarean section was low (15.7%). The rate of permanent neurologic impairment was 2.6 per 1000 deliveries.

CONCLUSION

Among nulliparous women, 84% were spared a possibly difficult Caesarean section in the second stage of labour or a potentially difficult operative vaginal delivery by allowing a longer second stage. However, surviving neonates had a higher risk of permanent neurologic handicap. Our study indicates that the optimal management of the second stage of labour remains controversial.