[The Association between Prolonged Second Stage in Primipara Women at Term and Excessive Hemorrhage According to the Mode of Delivery].

BACKGROUND

When prolonged second stage occurs, decisions regarding continuation of vaginal delivery, potentially further prolonging the second stage, or performing instrumental vaginal delivery or cesarean delivery (CD) should occur. It is important to know the specific risks in each mode of delivery in this setting. We assumed that prolonged second stage may increase the risk of complications, if CD would be performed.

OBJECTIVES

To investigate the association between the duration of the second stage of labor in primipara women and excessive hemorrhage in each mode of delivery.

METHODS

Retrospective cohort study including all nulliparous women delivering between 37 to 42 weeks at our medical center between 2005 and 2021. Deliveries were grouped by mode of delivery (CD, vaginal, or operative vaginal delivery) and by length of second stage. Outcomes were compared between prolonged and non-prolonged second stages in each mode of delivery.

RESULTS

Overall, 77,639 women met the study criteria, prolonged second stage did not affect the bleeding rate among those who had CD, even though it did increase the bleeding rate among women who had vaginal and instrumental deliveries. Additionally, the prolonged second stage impacts several other maternal and neonatal outcomes, especially in vaginal and instrumental deliveries.

CONCLUSIONS

In the absence of other indications to abandon the vaginal delivery process, it is possible to allow the delivery attempt to proceed without increasing bleeding risk if cesarean delivery would be necessary. Such knowledge may inform the development of clinical guidelines for decision-making in cases of prolonged second stage, enhancing patient care and outcomes.