Molly R Altman1, Mona T Lydon-Rochelle. 1. Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, Washington, USA.
Abstract
BACKGROUND: Safe and effective management of the second stage of labor presents a clinical challenge for laboring women and practitioners of obstetric care. This systematic review was conducted to evaluate evidence for the influence of prolonged second stage of labor on the risk of selected adverse maternal and neonatal outcomes. METHODS: Articles were searched using PubMed, Cochrane Library, and CINAHL from 1980 until 2005. Studies were included according to 3 criteria: if they reported duration of the second stage of labor, if they reported maternal and/or neonatal outcomes in relation to prolonged second stage, and if they reported original research. RESULTS: Our systematic review found evidence of a strong association between prolonged second stage and operative delivery. Although significant associations with maternal outcomes such as postpartum hemorrhage, infection, and severe obstetric lacerations were reported, inherent limitations in methodology were evident in the studies. Recurrent limitations included oversimplified categorization of second stage, inconsistency in study population characteristics, and lack of control of confounding factors. No associations between prolonged second stage and adverse neonatal outcomes were reported. CONCLUSIONS: The primary findings of our review indicated that most of the studies are flawed and do not answer the important questions for maternity caregivers to safely manage prolonged second stage. Meanwhile, approaches for promoting a normal second stage of labor are available to caregivers, such as maternal positioning and pain relief measures and also promoting effective pushing technique.
BACKGROUND: Safe and effective management of the second stage of labor presents a clinical challenge for laboring women and practitioners of obstetric care. This systematic review was conducted to evaluate evidence for the influence of prolonged second stage of labor on the risk of selected adverse maternal and neonatal outcomes. METHODS: Articles were searched using PubMed, Cochrane Library, and CINAHL from 1980 until 2005. Studies were included according to 3 criteria: if they reported duration of the second stage of labor, if they reported maternal and/or neonatal outcomes in relation to prolonged second stage, and if they reported original research. RESULTS: Our systematic review found evidence of a strong association between prolonged second stage and operative delivery. Although significant associations with maternal outcomes such as postpartum hemorrhage, infection, and severe obstetric lacerations were reported, inherent limitations in methodology were evident in the studies. Recurrent limitations included oversimplified categorization of second stage, inconsistency in study population characteristics, and lack of control of confounding factors. No associations between prolonged second stage and adverse neonatal outcomes were reported. CONCLUSIONS: The primary findings of our review indicated that most of the studies are flawed and do not answer the important questions for maternity caregivers to safely manage prolonged second stage. Meanwhile, approaches for promoting a normal second stage of labor are available to caregivers, such as maternal positioning and pain relief measures and also promoting effective pushing technique.
Authors: Maria Altman; Anna Sandström; Gunnar Petersson; Thomas Frisell; Sven Cnattingius; Olof Stephansson Journal: Eur J Epidemiol Date: 2015-05-26 Impact factor: 8.082
Authors: Javier A Schvartzman; Hugo Krupitzki; Ana Pilar Betran; Jennifer Requejo; Eduardo Bergel; Angel E Fiorillo; Enrique C Gadow; Francisco M Vizcaino; Felicitas von Petery; Fernando Althabe; Jose Belizan; Franco Borruto; Michel Boulvain; Gian Carlo Di Renzo; Metin Gülmezoglu; Justus Hofmeyr; Kevin Judge; Tak Yeung Leung; My Huong Nguyen; Ola Didrik Saugstad; Marleen Temmerman; Alain Treisser; Effy Vayena; Mario Merialdi Journal: Reprod Health Date: 2013-07-02 Impact factor: 3.223