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Second-stage labor: consensus versus science.

David B Nelson1, Donald D McIntire1, Kenneth J Leveno1

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Summary
This summary is machine-generated.

Lengthening the second stage of labor beyond historical limits may increase risks. Current evidence suggests that extending the second stage of labor is unsafe, challenging recent obstetric guidelines.

Keywords:
cesarean deliverydelayed pushingepidurallaborneuraxial analgesiasecond stage of labor

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Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine
  • Clinical Practice Guidelines

Background:

  • Rising national cesarean delivery rates have prompted changes in labor management practices.
  • A 2014 consensus suggested reconsidering labor duration limits, particularly in the second stage.
  • Previous clinical opinions have challenged these revised second-stage labor management recommendations.

Purpose of the Study:

  • To review and clarify the current evidence and consensus statements regarding second-stage labor management.
  • To re-evaluate the safety and efficacy of prolonged second-stage labor durations.
  • To address the shift from traditional obstetric precepts to newer management guidelines.

Main Methods:

  • Structured review of scientific literature and national organization statements published over the past two years.
  • Analysis of data supporting or refuting revised second-stage labor management.
  • Chronological examination of the evolution of obstetric practices for second-stage labor.

Main Results:

  • Multiple reports and national statements since 2016 support revised second-stage labor management.
  • The authors' prior position challenging extended labor durations is reinforced by recent data.
  • Evidence suggests that prolonging the second stage of labor beyond historical norms is associated with increased risks.

Conclusions:

  • The evolving evidence supports a return to historical precepts for managing the second stage of labor.
  • Extending the second stage of labor to 4 hours, as recommended by some guidelines, may be unsafe.
  • Further evaluation is needed to ensure patient safety amidst changing labor management practices.