Birth outcome in patients presenting for hospital delivery in the second stage of labour

Even though women in labour are expected to be managed in the hospital under the care of an Obstetrician, a subset of women, who actually plan to have hospital delivery spent greater part of their labour at home without any medical assistance and only present to the labour room at full cervical dilatation.

To compare the maternal and neonatal outcome in patients that present in the second stage of labour and those that present in the active phase of labour before full cervical dilatation.

This was a prospective case - control study comparing the maternal and neonatal outcomes of women who planned hospital delivery but presented to the labour ward of the University of Maiduguri Teaching Hospital at full cervical dilatation, following an unsupervised first stage at home. For each case, the next two patients that presented for delivery in the active phase of labour were used as controls. The study was conducted between 1st January 2013 to 31st December 2013 and only booked and low risk pregnancies were recruited. Independent sample t-test was used to compare continuous variables. For categorical data, Pearson's chi-square or Fisher's exact test was utilized for comparisons. A P value less than 0.05 was considered significant

The incidence of home labour was 11.54% (335/2902). The mean age, gestational age at delivery and birth weights were comparable in the 2 groups with p values of 0.724, 0.787 and 0.618 respectively. However, the parity and the estimated blood loss were significantly higher in the Home labour group compared to the Hospital labour group. Interventions such as augmentation of labour, episiotomy and caesarean delivery were higher among those that laboured in the hospital compared to those that laboured at home. However, post partum haemorrhage occurred in 6.3% of the Home labour group compared to 0.94% of the Hospital labour group and the differences were statistically significant. The neonatal outcomes were similar in the two groups.

Our finding showed that women that present for hospital delivery in the second stage of labour have increased risk of post partum haemorrhage but the risk of labour augmentation, episiotomy and caesarean delivery is lowered. We advocate that women should be encouraged to present to the labour ward early in labour to avoid hasty delivery and risk post partum haemorrhage.