Scholarlink

Purpose <p>To evaluate the obstetric outcomes in nulliparas with epidural who exceeded the 95th percentile duration of 4&#xa0;h.</p> Methods <p>This retrospective cohort included all term, singleton deliveries of nulliparas with epidural analgesia and second stage duration &gt; 3&#xa0;h, from 2014 to 2021. Maternal and neonatal outcomes were evaluated by comparing second stage duration 3–4&#xa0;h vs. &gt; 4&#xa0;h.</p> Results <p>A total of 2,798 deliveries were included, with 2273 in the 3–4&#xa0;h group (mean duration 3.42 ± 0.28&#xa0;h) and 525 in the &gt; 4&#xa0;h group (mean duration 4.38 ± 0.42&#xa0;h). Compared to the 3–4&#xa0;h group, the &gt; 4&#xa0;h group had lower rate of vaginal deliveries (80.4% vs. 93%, p &lt; 0.001), relatively higher rate of vacuum extractions (VE) (56.0% vs. 42.4%, p &lt; 0.001) and higher rate of cesarean deliveries (CD) (19.6% vs. 7.0%, p &lt; 0.001). The &gt; 4&#xa0;h group had higher rates of macrosomia and large for gestational age birthweights (7.0% vs. 4.0%, p &lt; 0.003 and 11.8% vs. 8.9%, p = 0.039, respectively). Shoulder dystocia, neonatal subgaleal hematoma and failed VE were more common in the &gt; 4&#xa0;h group (2.7% vs. 1.1%, 9.0% vs. 3.3% and 4.4% vs. 1.0%, respectively, p &lt; 0.01 for all), as well as the composite neonatal trauma outcome (11.2% vs. 4.1%, p &lt; 0.001). Multivariable logistic regression adjusted for confounders including obesity, hypertensive disorders, diabetes, macrosomia and delivery mode, revealed that a duration of &gt; 4&#xa0;h was associated with increased risks of shoulder dystocia, subgaleal hematoma and failed VE.</p> Conclusion <p>Most patients achieve vaginal delivery even after a duration of &gt; 4&#xa0;h. However, it is associated with increased risks of neonatal birth trauma and failed VE<b>.</b></p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Second stage of labor beyond 4 h in nulliparous patients with epidural analgesia: implications and outcomes—a retrospective cohort

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2025年8月5日

查看全文
  • Gal Cohen,
  • Michal Kovo,
  • Hila Shalev-Ram,
  • Chen Key-Segal,
  • Gil Shechter-Maor,
  • Tal Biron-Shental,
  • Hanoch Schreiber

摘要

Purpose

To evaluate the obstetric outcomes in nulliparas with epidural who exceeded the 95th percentile duration of 4 h.

Methods

This retrospective cohort included all term, singleton deliveries of nulliparas with epidural analgesia and second stage duration > 3 h, from 2014 to 2021. Maternal and neonatal outcomes were evaluated by comparing second stage duration 3–4 h vs. > 4 h.

Results

A total of 2,798 deliveries were included, with 2273 in the 3–4 h group (mean duration 3.42 ± 0.28 h) and 525 in the > 4 h group (mean duration 4.38 ± 0.42 h). Compared to the 3–4 h group, the > 4 h group had lower rate of vaginal deliveries (80.4% vs. 93%, p < 0.001), relatively higher rate of vacuum extractions (VE) (56.0% vs. 42.4%, p < 0.001) and higher rate of cesarean deliveries (CD) (19.6% vs. 7.0%, p < 0.001). The > 4 h group had higher rates of macrosomia and large for gestational age birthweights (7.0% vs. 4.0%, p < 0.003 and 11.8% vs. 8.9%, p = 0.039, respectively). Shoulder dystocia, neonatal subgaleal hematoma and failed VE were more common in the > 4 h group (2.7% vs. 1.1%, 9.0% vs. 3.3% and 4.4% vs. 1.0%, respectively, p < 0.01 for all), as well as the composite neonatal trauma outcome (11.2% vs. 4.1%, p < 0.001). Multivariable logistic regression adjusted for confounders including obesity, hypertensive disorders, diabetes, macrosomia and delivery mode, revealed that a duration of > 4 h was associated with increased risks of shoulder dystocia, subgaleal hematoma and failed VE.

Conclusion

Most patients achieve vaginal delivery even after a duration of > 4 h. However, it is associated with increased risks of neonatal birth trauma and failed VE.