International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2026
Maternal outcomes according to fetal head station at diagnosis of the second stage of labor.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Gilboa Itamar, Gabbai Daniel, Lavie Anat, Rosentveig Or, Baruch Yoav, Yogev Yariv, Attali Emmanuel
Аннотация
OBJECTIVE: This study determines the association between fetal head station (FHS) at the diagnosis of the second stage of labor and adverse maternal outcomes.
METHODS: This retrospective cohort study was conducted at a single university-affiliated tertiary medical center from 2011 to 2023, including singleton vertex deliveries at ≥ 37 weeks of gestation. Participants were stratified by parity FHS at the diagnosis of the second stage: nulliparous (Group A: above the ischial spines, Group B: at the ischial spines, Group C: below the ischial spines) and multiparous (Group α: above the ischial spines, Group β: at the ischial spines, Group γ: below the ischial spines). The composite maternal outcome included red blood cell transfusion, third- or fourth-degree perineal tears, postpartum fever ≥38°C, intensive care unit admission, rehospitalization, or surgery within 6 weeks postpartum.
RESULTS: Of 146 194 deliveries, 64 349 were eligible (42 987 nulliparous; 21 362 multiparous). Among nulliparas, 8.0%, 34.9%, and 57.2% began the second stage above, at, and below the spines, respectively; corresponding multiparous rates were 14.7%, 27.8%, and 57.5%. Nulliparas in Group A had higher transfusion rates (2.7% vs. 1.9% and 1.4%; P < 0.001) and higher composite morbidity (5.6% vs. 4.6% and 4.1%; P < 0.001). In multivariable regression, FHS above the ischial spines remained independently associated with increased risk for red blood cell transfusion (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.1-1.9) and composite morbidity (OR 1.3, 95% CI 1.1-1.5). No association was observed among multiparous women.
CONCLUSION: In nulliparous women, a higher FHS at the onset of the second stage of labor is independently associated with an increased risk of postpartum complications, irrespective of second stage duration.
METHODS: This retrospective cohort study was conducted at a single university-affiliated tertiary medical center from 2011 to 2023, including singleton vertex deliveries at ≥ 37 weeks of gestation. Participants were stratified by parity FHS at the diagnosis of the second stage: nulliparous (Group A: above the ischial spines, Group B: at the ischial spines, Group C: below the ischial spines) and multiparous (Group α: above the ischial spines, Group β: at the ischial spines, Group γ: below the ischial spines). The composite maternal outcome included red blood cell transfusion, third- or fourth-degree perineal tears, postpartum fever ≥38°C, intensive care unit admission, rehospitalization, or surgery within 6 weeks postpartum.
RESULTS: Of 146 194 deliveries, 64 349 were eligible (42 987 nulliparous; 21 362 multiparous). Among nulliparas, 8.0%, 34.9%, and 57.2% began the second stage above, at, and below the spines, respectively; corresponding multiparous rates were 14.7%, 27.8%, and 57.5%. Nulliparas in Group A had higher transfusion rates (2.7% vs. 1.9% and 1.4%; P < 0.001) and higher composite morbidity (5.6% vs. 4.6% and 4.1%; P < 0.001). In multivariable regression, FHS above the ischial spines remained independently associated with increased risk for red blood cell transfusion (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.1-1.9) and composite morbidity (OR 1.3, 95% CI 1.1-1.5). No association was observed among multiparous women.
CONCLUSION: In nulliparous women, a higher FHS at the onset of the second stage of labor is independently associated with an increased risk of postpartum complications, irrespective of second stage duration.