Risks associated with cesarean delivery during prolonged second stage of labor

Area of Science:

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

Background:

• Limited data exist on maternal and fetal morbidities related to the duration of the second stage of labor during cesarean delivery.
• Existing research primarily focuses on surgical morbidity per hour of delay.

Purpose of the Study:

• To quantify perinatal morbidities associated with cesarean delivery based on the duration of the second stage of labor.
• To provide evidence for improved patient counseling regarding labor progression and delivery outcomes.

Main Methods:

• Retrospective cohort study utilizing the Consortium on Safe Labor database.
• Inclusion of term, singleton pregnancies in cephalic presentation, excluding stillbirth or contraindications to vaginal delivery.
• Cesarean deliveries grouped by second stage of labor duration: ≤3, 3-4, 4-5, 5-6, and >6 hours.

Main Results:

• No statistically significant differences in composite maternal or neonatal morbidity outcomes were observed across groups.
• Increased duration of the second stage of labor was associated with extended maternal length of stay (>5 days) and increased birthweight.
• Rates of chorioamnionitis, wound complications, postpartum hemorrhage, and thrombosis did not increase with longer second stage duration.

Conclusions:

• Cesarean delivery during a prolonged second stage of labor does not appear to significantly increase composite maternal or neonatal morbidities.
• Healthcare providers should counsel patients on the duration of the second stage of labor, acknowledging that associated risks for cesarean delivery may not be as high as previously anticipated.