Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama.
Am J Perinatol. 2020 Oct;37(12):1201-1207. doi: 10.1055/s-0040-1708799. Epub 2020 Mar 24.
The aim of this study is to assess the impact of a prolonged second stage of labor on maternal and neonatal outcomes by comparing women who had expectant management versus operative intervention beyond specified timeframes in the second stage of labor.
Retrospective cohort including live singletons at ≥36 weeks who reached the second stage of labor. Expectant management (second stage >3, 2, 2, and 1 hour in nulliparas with an epidural, nulliparas without an epidural, multiparas with an epidural, and multiparas without an epidural, respectively) was compared with those who had an operative delivery (vaginal or cesarean) prior to these timeframes. The primary maternal outcome was a composite of postpartum hemorrhage, chorioamnionitis, operative complications, postpartum infections, and intensive care unit admission. The primary neonatal outcome was a composite of cord blood acidemia, 5-minute Apgar's score <5, chest compressions or intubation at birth, sepsis, seizures, birth injury, death, transfer to a long-term care facility, and respiratory support for >1 day.
Among 218 women, 115 (52.8%) had expectant management. Expectant management was associated with a significantly increased risk of the maternal composite (adjusted odds ratio [aOR]: 1.99, 95% confidence interval [CI]: 1.09-3.64) but not the neonatal composite (aOR: 1.54, 95% CI: 0.71-3.35).
Expectant management of a prolonged second stage was associated with a higher rate of adverse maternal outcomes, but the rate of adverse neonatal outcomes was not significantly increased.
本研究旨在通过比较第二产程中期待管理与特定时间后手术干预的产妇和新生儿结局，评估第二产程延长对母婴结局的影响。
本研究为回顾性队列研究，纳入≥36 周的单胎活产产妇，且进入第二产程。期待管理（第二产程>3、2、2 和 1 小时的初产妇硬膜外分娩、无硬膜外分娩的初产妇、有硬膜外分娩的经产妇和无硬膜外分娩的经产妇）与这些时间框架前进行手术分娩（阴道分娩或剖宫产）的产妇进行比较。主要的产妇结局是产后出血、绒毛膜羊膜炎、手术并发症、产后感染和重症监护病房入住的复合结局。主要的新生儿结局是脐血酸中毒、5 分钟 Apgar 评分<5、出生时需心肺复苏或气管插管、败血症、癫痫发作、出生损伤、死亡、转至长期护理机构和>1 天需要呼吸支持的复合结局。
在 218 名产妇中，115 名（52.8%）接受了期待管理。期待管理与产妇复合结局的风险显著增加相关（调整后的优势比[aOR]：1.99，95%置信区间[CI]：1.09-3.64），但与新生儿复合结局无关（aOR：1.54，95%CI：0.71-3.35）。
第二产程延长的期待管理与更高的不良产妇结局发生率相关，但不良新生儿结局发生率无显著增加。
