Open AccessProlonged passive second stage of labor in nulliparous women—Prevalence and risk factors: A historical cohort study
Author(s) -
Bjelke Maria,
Thurn Lars,
Oscarsson Marie
Publication year - 2022
Publication title -
acta obstetricia et gynecologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.401
H-Index - 102
eISSN - 1600-0412
pISSN - 0001-6349
DOI - 10.1111/aogs.14342
Subject(s) - medicine , odds ratio , obstetrics , confidence interval , body mass index , pregnancy , logistic regression , cohort , cohort study , stage (stratigraphy) , cervix , gynecology , cancer , paleontology , genetics , biology
This study examined the prevalence of and risk factors for a prolonged passive second stage of labor in nulliparous women. Material and Methods This was a historical cohort study of all nulliparous women ( n = 1131) at two delivery units in Sweden. Maternal and obstetric data were obtained from electronic medical records during 2019. Duration of the passive second stage was measured as time from retracted cervix to start of pushing. Prolonged passive second stage was defined as ≥2 h. Prevalence was calculated and associations between prolonged passive second stage and maternal, obstetric and neonatal characteristics and potential risk factors were assessed using logistic regression models. Results The prevalence of prolonged passive second stage was 37.6%. Factors associated with an increased risk of prolonged passive second stage were epidural analgesia (adjusted odds ratio [aOR] 3.93; 95% confidence interval [CI] 2.90–5.34), malpresentation (aOR 2.26; 95% CI 1.27–4.05), maternal age ≥ 30 years (aOR 2.00; 95% CI 1.50–2.65) and birthweight ≥ 4 kg (aOR 1.50; 95% CI 1.05–2.15). Maternal body mass index ≥30 (aOR 0.52; 95% CI 0.34–0.79) and noncohabiting (aOR 0.51; 95% CI 0.30–0.89) reduced the odds of prolonged passive second stage. Conclusions A prolonged passive second stage of labor in nulliparous women is common ( n = 425 [38%]). We found epidural analgesia, malpresentation, maternal age ≥ 30 years and birthweight ≥4 kg to be major risk factors associated with an increased risk of a prolonged passive second stage. Birth outcomes for prolonged passive second stage need to be investigated to strengthen evidence for the management of the second stage of labor.