Does a Long Second Stage of Labor Predict Preterm Risk in the Next Pregnancy?
BACKGROUND AND PURPOSE:
There is concern that a prolonged second stage of labor may result in injury to the cervix, leading to subsequent preterm birth
Quiñones et al. (AJOG 2018) analyzed whether the length of the second stage of labor in a first delivery is associated with an increased risk of preterm delivery
Retrospective cohort study
2 consecutive pregnancies
First delivery: Term (≥37 weeks), nulliparous
Subsequent second birth: Delivery >16w0d
Exposure: Second-stage duration, defined as time from complete dilation to delivery
Short: <30 minutes
Normal: 0–179 minutes
Prolonged: ≥180 minutes
Primary outcome: Spontaneous preterm delivery in the second pregnancy
90% power to detect a 1.5-fold increased risk of spontaneous preterm delivery with a prolonged second stage ≥180 minutes in the first pregnancy
6715 women were included
Short duration: 26.0%
Normal duration: 67.8%
Prolonged duration: 6.2%
Prolonged labor was associated with greater risk of spontaneous preterm delivery
Prolonged second stage: 5.4%
Normal labor duration: 3.5%
Adjusted hazard ratio (HR) 1.81 (95% confidence interval, 1.15–2.84)
This increased risk associated with prolonged second stage was mostly seen in women who underwent a cesarean
HR 3.38 (95% CI, 1.09–10.49)
Not significant for vaginal delivery (HR 1.52; 95% CI, 0.62–3.74)
Short second stage of labor was also associated with increased risk for preterm delivery but with ‘borderline’ significance
HR 1.28 (95% CI, 0.99–1.67)
Prolonged second stage in first term pregnancy was associated with a higher risk of spontaneous preterm delivery
This risk was even greater among women who were delivered by cesarean in the first pregnancy
The authors state
There may be unintended consequences of prolonging a second stage of labor ≥3 hours for nulliparous women with respect to the outcome of the next pregnancy, particularly in women who undergo a cesarean after a prolonged second stage of labor.
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