[Maternal effects of prolonged expulsive efforts]

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Perinatal Care

Background:

• Duration of expulsive efforts (DEE) has been linked to postpartum hemorrhage (PPH).
• Limited evidence exists on the association between DEE and severe perineal lacerations.
• Prolonged expulsive efforts (EE) may pose risks for maternal complications.

Purpose of the Study:

• To evaluate the impact of prolonged expulsive efforts (EE) beyond 45 minutes on maternal complications.
• Specifically, to assess the risk of severe perineal laceration associated with prolonged EE.
• To compare outcomes between instrumental vaginal delivery before 45 minutes and DEE longer than 45 minutes.

Main Methods:

• Retrospective study comparing two groups of women.
• Group 1: Instrumental vaginal delivery before 45 minutes for non-progression without FHR abnormalities.
• Group 2: Duration of expulsive efforts (DEE) longer than 45 minutes.
• Maternal outcomes (severe perineal lacerations, PPH) analyzed using uni- and multivariate analysis.

Main Results:

• Severe perineal lacerations were significantly higher in the group with instrumental delivery before 45 minutes (8.2% vs. 1.7%).
• The risk of severe perineal laceration remained significant after adjustment (adjusted OR=6.5).
• Postpartum hemorrhage (PPH) was higher in the prolonged EE group (12.9% vs. 3.5%), but not statistically significant after adjustment.

Conclusions:

• Prolonging expulsive efforts (EE) beyond 45 minutes can result in spontaneous vaginal delivery for over half of women with normal fetal heart rate (FHR).
• This strategy may decrease the risk of severe perineal laceration compared to limiting EE.
• The findings suggest a potential benefit of allowing longer expulsive efforts in specific obstetric scenarios.