Bakker Wouter, van Dorp Elisabeth, Phiri Timothy, Kazembe Misheck, Nkotola Alfred, van Roosmalen Jos, van den Akker Thomas
St. Luke's Hospital, Malosa, Malawi.
Athena Institute, Faculty of Science, VU University, Amsterdam, The Netherlands.
BMC Pregnancy Childbirth. 2025 May 7;25(1):542. doi: 10.1186/s12884-025-07392-8.
Prolonged second stage of labour may lead to maternal and perinatal complications. Options for clinical management are augmentation with oxytocin, instrumental vaginal birth or second-stage caesarean section. We aimed to describe incidence, management and outcome of prolonged second stage of labour in a rural hospital in Malawi.
Retrospective analysis of medical records and partographs of all women who gave birth in 2015-2016 in a rural mission hospital in Malawi, comparing labour tracings with management protocols. Primary outcomes were incidence of prolonged second stage, instrumental vaginal birth and caesarean section. Furthermore, management and outcomes were assessed. Women arriving in hospital in the second stage of labour were compared to women arriving in an earlier stage of labour.
Of all 3,426 women giving birth in the study period, 566 (16.5%) presented while already in the second stage. Based on their partographs, 307 (9.0% of 3426) were diagnosed with prolonged second stage. Of these women, 22 (7.2%) had labour augmented with oxytocin, 31 (10.1%) gave birth by vacuum extraction and 64 (20.9%) by caesarean section. Spontaneous vaginal birth occurred in 212 (69.0%). Women with prolonged second stage had an increased risk of having any complication, postpartum haemorrhage being the commonest. There was no difference in neonatal outcomes between women with or without a documented prolonged second stage. Of the 566 women presenting in the second stage, 538 (95.1%) had spontaneous vaginal births and 38 (6.7%) ended up having prolonged second stage registered in their partographs.
Prolonged second stage of labour was relatively common, and perhaps under-diagnosed due to a very sizeable proportion of women arriving whilst already in the second stage, of whom most gave birth spontaneously. Caesarean section occurred twice as often as vacuum extraction, suggesting a role for additional training and decision-making during childbirth to support the use of vacuum extraction.
第二产程延长可能导致孕产妇和围产期并发症。临床管理的选择包括使用缩宫素加强宫缩、器械助产阴道分娩或第二产程剖宫产。我们旨在描述马拉维一家农村医院第二产程延长的发生率、管理情况及结局。
对2015 - 2016年在马拉维一家农村教会医院分娩的所有妇女的病历和产程图进行回顾性分析，将产程记录与管理方案进行比较。主要结局指标为第二产程延长、器械助产阴道分娩和剖宫产的发生率。此外，还评估了管理情况和结局。将在第二产程入院的妇女与在更早产程入院的妇女进行比较。
在研究期间分娩的3426名妇女中，566名（16.5%）在入院时已处于第二产程。根据她们的产程图，307名（占3426名的9.0%）被诊断为第二产程延长。在这些妇女中，22名（7.2%）使用缩宫素加强宫缩，31名（10.1%）通过真空吸引助产，64名（20.9%）进行剖宫产。212名（69.0%）自然阴道分娩。第二产程延长的妇女发生任何并发症的风险增加，产后出血最为常见。有记录的第二产程延长的妇女与无记录的妇女之间，新生儿结局无差异。在566名第二产程入院的妇女中，538名（95.1%）自然阴道分娩，38名（6.7%）最终在产程图上记录为第二产程延长。
第二产程延长相对常见，可能由于相当大比例的妇女在入院时已处于第二产程且大多数自然分娩，导致诊断不足。剖宫产的发生率是真空吸引助产的两倍，这表明在分娩期间需要额外的培训和决策支持，以促进真空吸引助产的使用。
