Girault A, Lepelletier Mathilde, Le Ray Camille
Université Paris Cité, Institut Santé des femmes, U1153, Centre of Research In Epidemiology and Statistics (CRESS), Obstetrical, Perinatal and Paediatric Epidemiology Research Team (EPOpé), INSERM, INRAE, Paris, France; Port-Royal Maternity Unit, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, FHU préma, 123 Bd de Port-Royal, 75014 Paris, France.
Université Paris Cité, Institut Santé des femmes, U1153, Centre of Research In Epidemiology and Statistics (CRESS), Obstetrical, Perinatal and Paediatric Epidemiology Research Team (EPOpé), INSERM, INRAE, Paris, France; Port-Royal Maternity Unit, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, FHU préma, 123 Bd de Port-Royal, 75014 Paris, France.
Eur J Obstet Gynecol Reprod Biol. 2025 Jan;304:63-69. doi: 10.1016/j.ejogrb.2024.11.010. Epub 2024 Nov 22.
To describe the rate of prolonged second stage of labor in France before and after the publication of labor guidelines and to investigate the association of prolonged second stage with postpartum hemorrhage (PPH), perineal tears, and neonatal morbidity.
Data were obtained from the 2016 and 2021 French National Perinatal Surveys. For this cross-sectional analysis, we included patients with singleton pregnancies who gave birth to a term live neonate in cephalic presentation. Patients who did not reach full dilation, with a prior cesarean delivery or without an epidural were excluded. Prolonged second stage was defined as a duration from full dilation to delivery exceeding 3 h for nulliparous and 2 h for multiparous patients. Endpoints were severe PPH (>1000 ml blood loss or need for transfusion/embolization/surgery), severe perineal tears (third- and fourth degree), and neonatal morbidity (arterial cord pH < 7.10, 5-minute Apgar < 7, or NICU admission). Comparisons between periods were made using chi-square, Fisher, or Wilcoxon tests. Multivariable logistic regression and propensity score matching were used to control for confounders.
Of 27,297 patients in the surveys, 13,063 met inclusion criteria (6,695 in 2016; 6,368 in 2021). Prolonged second stage was more frequent in 2021 (nulliparous: 24.9 % vs 11.4 %; multiparous: 14.9 % vs 10.2 %, both p < 0.01). Severe PPH increased (2.1 % in 2021 vs 1.3 % in 2016, p < 0.01), while severe perineal tears and neonatal morbidity did not differ significantly. Nulliparous patients with prolonged second stage had higher rates of severe PPH (3.4 % vs 1.6 %, p < 0.01) and severe perineal tears (2.1 % vs 1.3 %, p = 0.03), but not neonatal morbidity. Multiparous patients with prolonged second stage showed higher severe PPH (3.3 % vs 1.2 %, p < 0.01), but no significant differences in perineal tears or neonatal morbidity. Multivariable and propensity score analyses confirmed these associations.
Following the 2017 guidelines, the rate of prolonged second stage of labor in France increased, accompanied by higher severe PPH risk but not severe perineal tears or neonatal morbidity. Balanced clinical strategies are needed to optimize maternal and neonatal outcomes.
描述法国分娩指南发布前后第二产程延长的发生率，并调查第二产程延长与产后出血（PPH）、会阴撕裂和新生儿发病率之间的关联。
数据来自2016年和2021年法国国家围产期调查。在这项横断面分析中，我们纳入了单胎妊娠、头先露且分娩足月活产新生儿的患者。未达到宫口全开、既往有剖宫产史或未行硬膜外麻醉的患者被排除。第二产程延长定义为从宫口全开到分娩的时间，初产妇超过3小时，经产妇超过2小时。观察终点为严重PPH（失血>1000ml或需要输血/栓塞/手术）、严重会阴撕裂（三度和四度）和新生儿发病率（脐动脉血pH<7.10、5分钟阿氏评分<7或入住新生儿重症监护病房）。采用卡方检验、Fisher检验或Wilcoxon检验对不同时期进行比较。使用多变量逻辑回归和倾向得分匹配来控制混杂因素。
在调查的27297例患者中，13063例符合纳入标准（2016年6695例；2021年6368例）。2021年第二产程延长更为常见（初产妇：24.9%对11.4%；经产妇：14.9%对10.2%，均p<0.01）。严重PPH增加（2021年为2.1%，2016年为1.3%，p<0.01），而严重会阴撕裂和新生儿发病率无显著差异。第二产程延长的初产妇严重PPH发生率较高（3.4%对1.6%，p<0.01），严重会阴撕裂发生率较高（2.1%对1.3%，p=0.03），但新生儿发病率无差异。第二产程延长的经产妇严重PPH发生率较高（3.3%对1.2%，p<0.01），但会阴撕裂或新生儿发病率无显著差异。多变量分析和倾向得分分析证实了这些关联。
遵循2017年指南后，法国第二产程延长的发生率增加，同时严重PPH风险升高，但严重会阴撕裂或新生儿发病率未升高。需要采取平衡的临床策略来优化母婴结局。
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