Prolonged second stage in nulliparous with epidurals: a systematic review

Area of Science:

• Obstetrics
• Maternal-Fetal Medicine
• Clinical Obstetrics

Background:

• Prolonged second stage of labor presents management challenges, particularly in nulliparous women receiving epidurals.
• Identifying maternal and fetal morbidities is crucial for optimizing care in these cases.

Purpose of the Study:

• To evaluate maternal and fetal morbidities associated with prolonged second stage of labor.
• To specifically assess outcomes in nulliparous women who have received epidural analgesia.

Main Methods:

• Systematic literature review using PubMed, Ovid, and Scopus databases.
• Inclusion of retrospective case series defining prolonged second stage as 3 hours or more.
• Primary outcome measured was the incidence of cesarean delivery.

Main Results:

• Two retrospective series comprising 5,350 nulliparous women with prolonged second stage were analyzed.
• Epidural analgesia was present in 76.3% of these women.
• Cesarean delivery occurred in 19.8% of nulliparous women with prolonged second stage and an epidural, while 80.2% achieved vaginal delivery.

Conclusions:

• A significant majority of nulliparous women with a prolonged second stage of labor and epidural analgesia deliver vaginally.
• These findings suggest that vaginal delivery is a common outcome even with extended labor durations and epidural use in this population.