Durations of first and second stage of labour and perinatal outcome

To investigate the duration of active first and second stage of labour, specifically the new alert values recommended by the World Health Organisation in 2018, in relation to intrapartum stillbirths and 24-h newborn outcome (i.e. 24-h perinatal outcome).

A prospective observational study including deliveries at Haydom Lutheran Hospital in rural Tanzania between March 2013 through November 2018. Information about labour, delivery and newborn characteristics/outcome was recorded on data collection forms by trained data collectors, observing every delivery. Of 22,199 deliveries 12,481 were included. Exclusion criteria were: missing time variables, caesarean section, multiples and antepartum stillbirths. Logistic regression was used to model whether duration of labour was associated with risk of adverse outcome. Our main outcome measure was 24-h perinatal outcome.

24-h postpartum, 454 (3.6 %) newborns were dead (intrapartum stillbirths n = 118, newborn deaths n = 63) or admitted to Neonatal Unit (n = 273). Duration of first stage was categorised: <6 (n = 900), 6- < 12 (n = 9204), and ≥ 12 h (n = 2377), with no significant relation to adverse perinatal outcome for either group (p = 0.431). Duration of second stage was categorised: <1 (n = 12,342) and ≥ 1 h (n = 139). Duration ≥1 h was associated with adverse perinatal outcome, OR 3.38 (95 % CI 1.95-5.88) when adjusted for foetal heart rate during labour and before delivery, gestational age and birth weight.

Duration of first stage was not associated with adverse outcome. Second stage ≥1 h was associated with adverse outcome by more than a three-fold. Our findings are not in accordance with the new recommendations from the World Health Organisation.