ArticleBMC pregnancy and childbirth2023
Maternal and perinatal outcomes of prolonged second stage of labour: a historical cohort study of over 51,000 women.
Article in BMC pregnancy and childbirth, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.
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Who cites it
13 citing papers in PubMed, 1 synthesis or guideline pooled it, 26 citations in OpenAlex.
- Evaluating the impact of the second-stage and pushing duration on maternal and neonatal outcomes: a systematic review and meta-analysis.American journal of obstetrics and gynecology · 2025Pooled it
- Physiotherapist-led ultrasound-guided visual biofeedback prelabor training: a randomised controlled trial.BMC pregnancy and childbirth · 2026Trial
- Impact of Upright Position during the First Stage of Labour on Maternal Outcomes: A Randomized Controlled Trial.Reviews on recent clinical trials · 2025Trial
- Effect of auriculotherapy on labor pain severity and labor duration: a clinical trial.Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia · 2025Trial
- Clinical predictors of postpartum vaginal and vulvar hematomas and the need for surgical treatment.Pregnancy (Hoboken, N.J.) · 2026Article
- Comparison of labor duration between combined spinal-epidural analgesia and dural puncture epidural analgesia: a retrospective, observational study.Journal of anesthesia · 2026Article
- Perineal body length as a predictor of severe perineal lacerations in a Turkish obstetric cohort.Scientific reports · 2026Observational
- Influence of the active second stage of labor in nulliparous women on umbilical cord blood pH and neonatal outcomes: a population-based, cohort study.BMC pregnancy and childbirth · 2025Article
- Adverse perinatal outcomes and associated factors among mothers of advanced age at a tertiary hospital, Southwestern Uganda: a cross-sectional study.BMC pregnancy and childbirth · 2025Article
- Artificial intelligence-based prediction of second stage duration in labor: a multicenter retrospective cohort analysis.EClinicalMedicine · 2025Article
- Prolonged second stage of labor and risk of postpartum hemorrhage in nullipara with epidural anesthesia and vaginal delivery: A cohort study with propensity score analysis.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2025Article
- Use of the WHO partograph and Zhang's guideline for labor and delivery in China: implications for clinical practice.BMC pregnancy and childbirth · 2024Article
- Obstetric interventions' effects on the birthing experience.BMC pregnancy and childbirth · 2024Article
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Authors and funding
7 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundProlonged second stage of labour has been associated with adverse maternal and perinatal outcomes. The maximum length of the second stage from full dilatation to birth of the baby remains controversial. Our aim was to determine whether extending second stage of labour was associated with adverse maternal and perinatal outcomes.
methodsA retrospective cohort study was conducted using routinely collected hospital data from 51592 births in Aberdeen Maternity Hospital between 2000 and 2016. The hospital followed the local guidance of allowing second stage of labour to extend by an hour compared to national guidelines since 2008 (nulliparous and parous). The increasing duration of second stage of labour was the exposure. Baseline characteristics, maternal and perinatal outcomes were compared between women who had a second stage labour of (a) ≤ 3 h and (b) > 3 h duration for nulliparous women; and (a) ≤ 2 h or (b) > 2 h for parous women. An additional model was run that treated the duration of second stage of labour as a continuous variable (measured in hours). All the adjusted models accounted for: age, BMI, smoking status, deprivation category, induced birth, epidural, oxytocin, gestational age, baby birthweight, mode of birth and parity (only for the final model).
resultsEach hourly increase in the second stage of labour was associated with an increased risk of obstetric anal sphincter injury (aOR 1.21 95% CI 1.16,1.25), having an episiotomy (aOR 1.48 95% CI 1.45, 1.52) and postpartum haemorrhage (aOR 1.27 95% CI 1.25, 1.30). The rates of caesarean and forceps delivery also increased when second stage duration increased (aOR 2.60 95% CI 2.50, 2.70, and aOR 2.44 95% CI 2.38, 2.51, respectively.) Overall adverse perinatal outcomes were not found to change significantly with duration of second stage on multivariate analysis.
conclusionsAs the duration of second stage of labour increased each hour, the risk of obstetric anal sphincter injuries, episiotomies and PPH increases significantly. Women were over 2 times more likely to have a forceps or caesarean birth. The association between adverse perinatal outcomes and the duration of second stage of labour was less convincing in this study.
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