Prolonged second stage of labor: how long is too long?

  • American Journal of Obstetrics & Gynecology MFM

  • von Elisabeth Aron, MD, MPH, FACOG
  • Clinical Essentials
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Takeaway

  • A prolonged second stage of labor is not associated with future risk of preterm birth.

Why this matters

  • Previous studies have suggested that a prolonged second stage of labor may be a risk factor for subsequent preterm birth.
  • Prolonged second stage is thought to contribute to cervical damage that might compromise cervical integrity for future pregnancies.

Key results

  • Overall rate of spontaneous preterm birth was 3.1%.
  • Overall prolonged second stage ≥4 hours in 24.4%; 70.6% of those went on to deliver vaginally.
  • Overall very prolonged second stage ≥7 hours in 4.3%; 45.4% of those went on to deliver vaginally.
  • No significant association between prolonged or very prolonged second stage of labor and subsequent preterm birth.

Study design

  • Retrospective cohort study.
  • Women with 2 consecutive deliveries between 2012 and 2018 were identified (n=1032).
  • Cohort stratified into normal second stage, prolonged second stage (≥4 hours), and very prolonged second stage (≥7 hours).
  • Primary outcome was spontaneous birth before 37 weeks.
  • Funding:  No external funding source.

Limitations

  • Participants from 1 institution; results may not be generalizable.