Title: Maternal and Neonatal Morbidity due to Prolonged Second Stage of Labour

Authors: Dr J. Bindal, Dr Shikha Asrani

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i4.10

Abstract

Background: A prolonged second stage is generally responsible for maternal and neonatal morbidities like postpartum hemorrhage, third or fourth degree perineal tears, operative modes of deliveries, increased risk of Apgar score less than 7, meconium passage and neonatal intensive care unit(NICU) admission.

Methodology: This is a prospective, observational study conducted at the Department of Obstetrics and Gynaecology at Gajra raja Medical College, Gwalior Madhya Pradesh, from January 2017 to June 2017 done on 500 cases. Study included uncomplicated primipara and multipara, single viable pregnancy, fetus in vertex position and gestational age > 37 weeks.

Results: Out of the total 500 patients, 286 were nulliarpous and 214 were multiparous. 15.7% of nulliparous patients had prolonged labour. 72 belongs to > 35 years age group, 33 of them had prolonged second stage of labour. Out of the total 70 patients with prolonged second stage of labour 55.8% underwent the vaginal delivery and 44.2% underwent caesarean section. Of the total 500 patients, 33 had perineal trauma of which 24 had prolonged second stage of labour. 39 had PPH of which 26 had prolonged second stage, 74 babies had low apgar score of which 46 had prolonged second stage. 86 were admitted in NICU for > 48 hrs of which 51 were born to mother with prolonged second stage of labour.

Conclusion: The maternal and perinatal morbidities increase with prolonged duration of the second stage of labour. Hence second stage of labour should be monitored with vigilance.

References

  1. American College of Obstetrics and Gynecology. Operative vaginal delivery. Clinical management guidelines for obstetrician gynecologists. American College of Obstetrics and Gynecology.Int J Gynaecol Obstet 2001;74:69–76.
  2. Intrapartum Care. Care of Healthy Women and their Babies During Childbirth. NICE Clinical Guidelines. London: NICE; 2007. pp. 55.
  3. Allen VM, Baskett TF, O’Connell CM, McKeen D, Allen AC. Maternal and perinatal outcomes with increasing duration of the second stage of labor. Obstet Gynecol. 2009;113:1248–58.
  4. Nystedt A, &Hildingsson I. Diverse definitions of prolonged labour and its consequences with sometimes subsequent inappropriate treatment. BMC pregnancy and childbirth.2014;14(1): 233.
  5. Sangeeta Shah, Preethi Reddy B .Effect of duration of second stage of labour on maternal and neonatal morbidity.Indian Journal of Obstetrics and Gynecology Research 2017;4(3):278-282.
  6. De Leeuw JW, Struijk PC, Vierhout ME, Wallenburgh C. Risk factors for third degree perineal ruptures during delivery. BJOG.2001;108:383–387.
  7. Rouse DJ, Weiner SJ, Bloom SL, Varner MW, Spong CY, Ramin SM, et al. Second-stage labor duration in nulliparous women: relationship to maternal and perinatal outcomes. Am J Obstet Gynecol. 2009;201:357.e1–7.
  8. Balki M, Dhumne S, Kasodekar S, Seaward Gareth, Carvalho CA. Blood Transfusion for Primary Postpartum Hemorrhage: A Tertiary Care Hospital Review. J Obstet Gynaecol. 2008;30 (11):1002-1007.
  9. Laughon SK, Berghella V, Reddy UM, Sundaram R, Lu Z, & Hoffman MK. Neonatal and maternal outcomes with prolonged second stage of labor. Obstet Gynaecol. 2014;124(1):57-67.
  10. Salustiano EMA, Campos JADB, Idibi SM, Ruano R, Zugaib M. Low Apgar scores at 5 minutes in a low risk population: maternal and obstetrical factors and postnatal outcome. Rev Assoc Med Bras. 2012;58(5):587-59.
  11. Shamsha A, Bai J, Raviraj P, Gyaneshwar R. Mode Of Delivery and its associated Maternal and Neonatal Outcomes. Open journal of Obstetrics and Gynaecology. 2013;3:307-312.

Corresponding Author

Dr Shikha Asrani

P.G. Student, Dept of Obstetrics and Gynaecology,

Kamla Raja Hospital, G.R. Medical College, Gwalior (M.P.), India