Cohen Gal, Kovo Michal, Shalev-Ram Hila, Key-Segal Chen, Shechter-Maor Gil, Biron-Shental Tal, Schreiber Hanoch
Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel.
School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
Arch Gynecol Obstet. 2025 Aug 5. doi: 10.1007/s00404-025-08141-0.
To evaluate the obstetric outcomes in nulliparas with epidural who exceeded the 95th percentile duration of 4 h.
This retrospective cohort included all term, singleton deliveries of nulliparas with epidural analgesia and second stage duration > 3 h, from 2014 to 2021. Maternal and neonatal outcomes were evaluated by comparing second stage duration 3-4 h vs. > 4 h.
A total of 2,798 deliveries were included, with 2273 in the 3-4 h group (mean duration 3.42 ± 0.28 h) and 525 in the > 4 h group (mean duration 4.38 ± 0.42 h). Compared to the 3-4 h group, the > 4 h group had lower rate of vaginal deliveries (80.4% vs. 93%, p < 0.001), relatively higher rate of vacuum extractions (VE) (56.0% vs. 42.4%, p < 0.001) and higher rate of cesarean deliveries (CD) (19.6% vs. 7.0%, p < 0.001). The > 4 h group had higher rates of macrosomia and large for gestational age birthweights (7.0% vs. 4.0%, p < 0.003 and 11.8% vs. 8.9%, p = 0.039, respectively). Shoulder dystocia, neonatal subgaleal hematoma and failed VE were more common in the > 4 h group (2.7% vs. 1.1%, 9.0% vs. 3.3% and 4.4% vs. 1.0%, respectively, p < 0.01 for all), as well as the composite neonatal trauma outcome (11.2% vs. 4.1%, p < 0.001). Multivariable logistic regression adjusted for confounders including obesity, hypertensive disorders, diabetes, macrosomia and delivery mode, revealed that a duration of > 4 h was associated with increased risks of shoulder dystocia, subgaleal hematoma and failed VE.
Most patients achieve vaginal delivery even after a duration of > 4 h. However, it is associated with increased risks of neonatal birth trauma and failed VE.
评估硬膜外麻醉的初产妇第二产程超过4小时（第95百分位数）的产科结局。
这项回顾性队列研究纳入了2014年至2021年期间所有接受硬膜外镇痛的足月单胎初产妇分娩，且第二产程持续时间>3小时。通过比较第二产程持续时间3 - 4小时与>4小时的产妇和新生儿结局。
共纳入2798例分娩，其中3 - 4小时组2273例（平均持续时间3.42±0.28小时），>4小时组525例（平均持续时间4.38±0.42小时）。与3 - 4小时组相比，>4小时组阴道分娩率较低（80.4%对93%，p<0.001），胎头吸引术（VE）率相对较高（56.0%对42.4%，p<0.001），剖宫产（CD）率较高（19.6%对7.0%，p<0.001）。>4小时组巨大儿和大于胎龄出生体重的发生率较高（分别为7.0%对4.0%，p<0.003和11.8%对8.9%，p = 0.039）。肩难产、新生儿帽状腱膜下血肿和胎头吸引术失败在>4小时组更常见（分别为2.7%对1.1%、9.0%对3.3%和4.4%对1.0%，p均<0.01），以及复合新生儿创伤结局（11.2%对4.1%，p<0.001）。对包括肥胖、高血压疾病、糖尿病、巨大儿和分娩方式等混杂因素进行多变量逻辑回归分析显示，持续时间>4小时与肩难产、帽状腱膜下血肿和胎头吸引术失败的风险增加有关。
即使第二产程持续时间>4小时，大多数患者仍能实现阴道分娩。然而，这与新生儿出生创伤和胎头吸引术失败的风险增加有关。
