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Objective: 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., Methods: 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., Results: 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., Conclusion: 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., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

The COVID-19 pandemic jeopardized individuals' health and economic stability, and the associated shocks might have decreased individuals' trust. In this paper, we study the relationship between subjective perceptions of the pandemic and individuals' institutional and interpersonal trust (e.g., trust towards the government or health representatives), while considering objective health and economic shocks due to the pandemic as drivers. We collected data across Australia, France, Germany, and South Africa during a later stage of the COVID-19 pandemic (i.e., from mid-April to early-June 2021) when individuals had time to personally experience the pandemic and its effects. COVID-19 illness perception was associated with lower institutional and interpersonal trust. The health shock of having experienced COVID-19 was associated with higher interpersonal trust, while economic shocks were associated with lower institutional trust when they were due to the pandemic. The results suggest that public policy interventions in a later stage of a pandemic should consider objective economic and health outcomes as well as subjective ones, such as individual's perceptions. Authorities should communicate in a way that helps concerned people understand that they can take control of their health and the possibility of infection, and reassure them that health measures such as vaccination can help prevent the spread of the virus., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier B.V. All rights reserved.)