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Objective: To determine the trends of instrumental vaginal delivery (IVD) and cesarean section (CS) at the Lagos University Teaching Hospital (LUTH), Nigeria, over 16 years, from 2002 to 2017. Methods: A retrospective cross‐sectional study. The case records of all women who had IVD and CS during the study period were reviewed. The trends in the IVD and CS rates were evaluated using join point regression modeling. The average annual percent change (AAPC) and annual percent change (APC) with associated 95% confidence interval of segmental trends were calculated. Results: The overall IVD rate was 1.36%. Vacuum delivery rate was higher than forceps (0.79% vs 0.57%). The CS rate was 44.9 per 100 deliveries; the rate increased by about 3.7% per annum. CS rates were 7.1–89.9 times the IVD rates within the study period. The number of IVDs performed in the hospital declined by about 83.02%, from 53 cases in 2002 to nine cases in 2017. Forceps delivery declined at a faster rate than vacuum delivery between 2002 and 2017 (AAPC for forceps: −12.6% [−17.5 to −7.5], P < 0.001 vs AAPC for vacuum: −6.2% [−14.3 to 2.7], P = 0.200). The commonest indication for IVD was prolonged second stage of labor (47/162, 29.01%) and shortening of the second stage of labor for maternal conditions (47/162, 29.01%). Conclusion: IVD rates are low and declining at LUTH. There is need to train accoucheurs on the safe use of IVDs to potentially reduce the CS rate. Synopsis: The present study corroborates global reports of declining IVD rates and increasing CS rates. There is need to increase IVD use to potentially reduce CS rate. [ABSTRACT FROM AUTHOR]

BACKGROUND : The recent advances in induction of labour has lead to decreased spontaneous labour and as a result increased complications. Thus a study is done to identify the progress of labour and fetomaternal outcomes in spontaneous versus induced labour patients as childbirth experience especially in primigravida have a major influence in family planning and subsequent pregnancies. AIM: To study the difference in progress, course and outcome between spontaneous and induced labours in a primigravida. MATERIALS AND METHODS: This is a prospective study undertaken on 100 Primigravidae of term gestation and uncomplicated pregnancy admitted in the labour room were studied and divided into 2 groups, those with induction of labor and those with spontaneous onset of labor. May 2022 to June 2023 was the time period in consideration. RESULTS: Among the study population, childbirth experience was poor in those with induced labour. The mean duration of second stage of labour was significantly more in induced labour (16.25 minutes) than in spontaneous labour (14.60 minutes)The caesarean section rates were higher in induced labour(33%) than in sponatenous labour(11%). The mean Apgar scores were comparable in two groups. CONCLUSION : The study shows that it is beneficial to wait for spontaneous onset of labor in a primigravida with no maternal or fetal complications since induction of labor is associated with higher caesarean rates, tears,prolonged labour,poor childbirth experience. It is essential to counsel the mother about the type of delivery. [ABSTRACT FROM AUTHOR]

Objective: To determine the cutoff of intertwin delivery intervals (IDIs) as a predictor for neonatal acidemia. Method: This retrospective cohort study was conducted at a single tertiary care center. Women attempting vaginal delivery of twins between 2010 and 2019 and who reached the second stage of labor were included. The cutoff point for prolonged IDI was established using a receiver operating characteristic (ROC) curve and Youden's J statistic. Maternal and neonatal outcomes were compared between short and prolonged IDI cohorts. Results: A total of 461 women were included in the study. A cutoff time of 10 min was found to be the best predictor for neonatal acidemia (arterial cord pH ≤ 7.1), with a sensitivity of 90% and a specificity of 59%. Second twins delivered more than 10 min after the first twin were more likely to be acidemic and to have a 5‐min Apgar score of 7 or less (13.5% vs 3.3%, P = 0.01, and 8.4% vs 3.2%, P = 0.02, respectively). An IDI of more than 10 min was also associated with increased rate of cesarean delivery and placental abruption (13.5% vs 0.8%, P < 0.001, and 3.4% vs 0.8%, P = 0.047, respectively). No other adverse maternal or neonatal outcomes were statistically significant between cohorts. Conclusion: An IDI of more than 10 min is associated with a higher risk for neonatal academia, with a low 5‐min Apgar score, and higher cesarean delivery and placental abruption rates. These findings provide insights that are valuable when counseling and managing twin pregnancies attempting vaginal delivery. Interventions aimed at shortening the IDI should be considered to prevent adverse neonatal outcomes. Synopsis: A 10‐min IDI cutoff is the best predictor for neonatal acidemia in twin deliveries, with implications for cesarean delivery and placental abruption risks. [ABSTRACT FROM AUTHOR]

Background: Friedman's standards, developed almost 50 years ago, may no longer align with the needs of today's obstetric population and current pregnancy management practices. This study aims to analyze contemporary labor patterns and estimate labor duration in China, focusing on first-stage labor data from Chinese parturients with a spontaneous onset of labor. Methods: This retrospective observational study utilized data from electronic medical records of a tertiary hospital in Changsha, Hunan. Out of a total of 2,689 parturients, exclusions were made for multiple gestations, preterm, post-term, or stillbirth, cesarean delivery, non-vertex presentation, and neonatal intensive care unit admission. Average labor curves were constructed by parity using repeated-measure analysis, and labor duration was estimated through interval-censored regression, stratified by cervical dilation at admission. We performed an analysis to assess the impact of oxytocin augmentation and amniotomy on labor progression and conducted a sensitivity analysis using women with complicated outcomes. Results: Nulliparous women take over 180 minutes for cervical dilation from 3 to 4 cm, and the duration from 5 to 6 cm exceeds 145 minutes. Multiparous women experience shorter labor durations than nulliparous. Labor acceleration is observed after 5 cm in nulliparous, but no distinct inflection point is evident in the average labor curve. In the second stage of labor, the 95th percentile for nulliparous, with and without epidural analgesia, is 142 minutes and 127 minutes, respectively. Conclusions: These findings provide valuable insights for the reassessment of labor and delivery processes in contemporary obstetric populations, including current Chinese obstetric practice. [ABSTRACT FROM AUTHOR]

Objective: To determine intrapartum factors associated with perineal laceration at delivery. Methods: This was a planned secondary analysis of a multicenter randomized clinical trial of delayed versus immediate pushing among term nulliparous women in labor with neuraxial analgesia conducted in the United States. Intrapartum characteristics were extracted from the medical charts. The primary outcome was perineal laceration, defined as second degree or above, characterized at delivery in women participating in longer term pelvic floor assessments post-delivery. Multivariable logistic regression was used to refine risk estimates while adjusting for randomization group, birth weight, and maternal age. Results: Among the 941 women participating in the pelvic floor follow-up, 40.6% experienced a perineal laceration. No first stage labor characteristics were associated with perineal laceration, including type of labor or length of first stage. Receiving an amnioinfusion appeared protective of perineal laceration (adjusted odds ratio, 0.48; 95% confidence interval 0.26–0.91; P = 0.01). Second stage labor characteristics associated with injury were length of stage (2.01 h vs. 1.50 h; adjusted odds ratio, 1.36; 95% confidence interval 1.18–1.57; P < 0.01) and a prolonged second stage (adjusted odds ratio, 1.64; 95% confidence interval 1.06–2.56; P < 0.01). Operative vaginal delivery was strongly associated with perineal laceration (adjusted odds ratio, 3.57; 95% confidence interval 1.85–6.90; P < 0.01). Conclusion: Operative vaginal delivery is a modifiable risk factor associated with an increased risk of perineal laceration. Amnioinfusion appeared protective against injury, which could reflect a spurious finding, but may also represent true risk reduction similar to the mechanism of warm perineal compress. Significance: The objective of this study was to examine intrapartum factors associated with an increased risk of perineal laceration at delivery among nulliparous women. Operative vaginal delivery and the length of second stage, particularly prolonged second stage, are modifiable risk factors associated with an increased risk of perineal laceration. Receiving an amnioinfusion appeared to be protective against perineal laceration. There are few intrapartum modifiable risk factors other than operative delivery for perineal laceration in nulliparous women. Length of the second stage is an important risk factor for perineal lacerations that is modifiable through active management. [ABSTRACT FROM AUTHOR]

Objective The objective of the study was to evaluate whether patients with oxytocin discontinued during the second stage of labor (≥30 minutes prior to delivery) had a lower rate of postpartum hemorrhage (PPH) compared with those with oxytocin continued until delivery or discontinued <30 minutes prior to delivery. Study Design Retrospective cohort study was performed from August 1, 2014 to July 31, 2019. Singleton pregnancies of 24 to 42 weeks gestation were included if they reached the second stage of labor and received oxytocin during labor. Patients on anticoagulants were excluded. Patients with oxytocin discontinued ≥30 minutes prior to delivery represented STOPPED and those with oxytocin continued until delivery or discontinued <30 minutes prior to delivery represented CONTINUED. Patient data were abstracted from the electronic medical record. The primary outcome was PPH (≥1,000 mL blood loss). Univariable analyses were performed to compare groups. Multi-variable logistic regression was performed to adjust for prespecified confounders. Planned sub-group analyses by the route of delivery were performed. Results Of 10,421 total patients, 1,288 had oxytocin STOPPED and 9,133 had oxytocin CONTINUED. There were no significant differences in age, race, or ethnicity, body mass index, public insurance, gestational diabetes, or pregnancy-induced hypertension between STOPPED and CONTINUED. The PPH rate was 15.2 and 5.7% in STOPPED and CONTINUED, respectively (p < 0.001). After adjusting for confounders, STOPPED remained at higher odds for PPH (adjusted odds ratio 2.859, 95% confidence interval 2.394, 3.414, p < 0.001). Among cesarean deliveries only, there was no significant difference in the rate of PPH between STOPPED and CONTINUED (38.0 vs. 36.4%, respectively, p = 0.730). However, among vaginal deliveries, the rate of PPH was actually lower in STOPPED than CONTINUED (3.4 vs. 5.2%, respectively, p = 0.024). Conclusion The rate of PPH was higher in patients with oxytocin STOPPED compared with CONTINUED. However, among vaginal deliveries, there was a significantly lower rate of PPH in STOPPED. These disparate findings may be explained by the variable impact of second-stage oxytocin on PPH as a function of delivery type. Key Points It is unclear if oxytocin use in the second stage of labor may independently increase the risk of hemorrhage. Patients with oxytocin discontinued during the second stage of labor had a higher rate of PPH. PPH was significantly lower among vaginal deliveries in patients with oxytocin discontinued. [ABSTRACT FROM AUTHOR]

Background: Evidence regarding the type and rate of intravenous (IV) fluid administration during labor is still inconclusive and the studies assessing the impact of IV fluids had mixed results. Objectives: To evaluate the effects of IV fluids at an infusion rate of 250 mL/h as compared with 125 mL/h on labor outcomes in nulliparous women. Search Strategy: We searched six databases for relevant studies through a search strategy containing the relevant keywords "IV hydration", "IV fluids", and "labor" from the inception of these databases to May 1, 2023, without any applied restrictions. Selection Criteria: Search results were imported to Covidence for screening of eligible articles for this review. Randomized controlled trials (RCTs) assessing the impact of IV fluids at 250 mL/h on the outcomes of labor in nulliparous women at term (>37 weeks) as compared with 125 mL/h were included only. Data Collection and Analysis: Data regarding the characteristics of included studies, participant's baseline characteristics, and concerned outcomes were collected in an Excel spreadsheet and all the concerned outcomes were pooled as risk ratios (RR) or mean difference (MD) with 95% confidence interval (CI) in the meta‐analysis models using RevMan 5.4. Main results: Pooled data from 11 RCTs with 1815 patients showed that 250 mL/h infusion rate had a significant reduction in cesarean section rate (RR 0.70, 95% CI 0.56–0.88, P = 0.002), the first stage of labor duration (MD –46.97, 95% CI –81.79 to −12.14, P = 0.008), the second stage of labor duration (MD –2.69, 95% CI –4.34 to −1.05, P = 0.001), prolonged labor incidence (RR 0.72, 95% CI 0.58–0.89, P = 0.003), as compared with 125 mL/h. Also, the vaginal delivery rate (RR 1.07, 95% CI 1.02–1.12, P = 0.009) was higher with a 250 mL/h infusion rate. Conclusion: IV fluids at an infusion rate of 250 mL/h during labor in nulliparous women decreased the cesarean delivery rate, increased the vaginal delivery rate, shortened the first and second‐stage labor duration, decreased the incidence of prolonged labor as compared with 125 mL/h. These findings suggest enhanced labor progression and a lower risk of labor complications with higher infusion rates. However, future research involving a more diverse population and exploring the potential benefits of combining IV infusion rates with other interventions, such as adding dextrose or less restrictive oral intake during labor, is needed. Synopsis: IV fluids at 250 mL/h reduce cesarean section rates and significantly affect the labor outcomes as compared with 125 mL/h. [ABSTRACT FROM AUTHOR]

Objective We determine whether racial concordance between postpartum patients and obstetric providers (dyads) impacts the perception of quality of care among people undergoing intrapartum obstetrical procedures. Study Design This is a prospective cohort study of postpartum people who underwent operative vaginal or cesarean deliveries in the second stage of labor. Participants were asked to identify the race of their primary provider and complete the Interpersonal Processes of Care (IPC) survey, which assesses communication, patient-centered decision-making, and interpersonal style. The association of participant-identified patient–provider racial concordance with IPC scores was determined. The primary outcome was the IPC subdomain related to discrimination, and secondary outcomes included other IPC subdomains and IPC results by participant racial identity (Black, LatinX vs. White). Sociodemographic and biomedical data were extracted from the medical record. Bivariable analyses were performed. Results Of 168 patients who were approached, 107 (63.6%) agreed to participate and 87 (81.3%) completed the survey. The majority (n =49) identified a racially discordant provider. Participants in racially concordant dyads were more likely to be older, White, use English as a primary language, complete a higher degree of education, and have a higher household income when compared with racially discordant dyads. Intrapartum outcomes were not significantly different between groups. Median IPC subtest scores were not significantly different between groups or between racial/ethnic identities. Conclusion There were no significant differences in perceptions of IPC between racially concordant versus discordant dyads. However, there is an ongoing need to further clarify measures of quality of care in high-acuity obstetrical situations to remediate ongoing racial and ethnic disparities in adverse health outcomes. Key Points Racial concordance between patient and clinician has been associated with improved quality of care. There are limited data on racial concordance and perceptions of operative obstetrical care (e.g., operative vaginal delivery). Racial concordance was not associated with differences in patient-perceived quality of care associated with operative obstetrics. [ABSTRACT FROM AUTHOR]

Objective We aimed to examine the relationship of sociodemographic variables with racial/ethnic disparities in unplanned cesarean births in a large academic hospital system. Secondarily, we investigated the relationship of these variables with differences in cesarean delivery indication, cesarean delivery timing, length of second stage and operative delivery. Study Design We conducted a retrospective cohort study of births >34 weeks between 2017 and 2019. Our primary outcome was unplanned cesarean delivery after a trial of labor. Multiple gestations, vaginal birth after cesarean, elective repeat or primary cesarean delivery, and contraindications for vaginal delivery were excluded. Associations between mode of delivery and patient characteristics were assessed using Chi-square, Fisher exact tests, or t -tests. Odds ratios were estimated by multivariate logistic regression. Goodness of fit was assessed with Hosmer Lemeshow test. Results Among 18,946 deliveries, the rate of cesarean delivery was 14.8% overall and 21.3% in nulliparous patients. After adjustment for age, body mass index (BMI), and parity, women of Black and Asian races had significantly increased odds of unplanned cesarean delivery; 1.69 (95% CI: 1.45,1.96) and 1.23 (1.08, 1.40), respectively. Single Hispanic women had adjusted odds of 1.65 (1.08, 2.54). Single women had increased adjusted odds of cesarean delivery of 1.18, (1.05, 1.31). Fetal intolerance was the indication for 39% (613) of cesarean deliveries among White women as compared to 63% (231) of Black women and 49% (71) of Hispanic women (p <0.001). Conclusion Rates of unplanned cesarean delivery were significantly higher in Black and Asian compared to White women, even after adjustment for age, BMI, parity, and zip code income strata, and rates of unplanned cesarean delivery were higher for Hispanic women self-identifying as single. Racial and ethnic differences were seen in cesarean delivery indications and operative vaginal deliveries. Future work is urgently needed to better understand differences in provider care or patient attributes, and potential provider bias, that may contribute to these findings. Key Points Racial, ethnic, and socioeconomic differences exist in the odds of unplanned cesarean. Indications for unplanned cesarean delivery differed significantly among racial and ethnic groups. There may be unmeasured provider level factors which contribute to disparities in cesarean rates. [ABSTRACT FROM AUTHOR]

Background: Relaparotomy following a cesarean delivery (CD) is an infrequent complication, with inconsistency regarding risk factors and indications for its occurrence. We therefore aimed to determine risk factors and indications for a relaparotomy following a CD at a single large tertiary center. Methods: A retrospective case-control single-center study (2013–2023). We identified all women who had a relaparotomy up to six weeks following a CD (study group). Maternal characteristics, obstetrical and surgical data were compared to a control group in a 1:2 ratio. Controls were women with a CD before and immediately after each case in the study group, who did not undergo a relaparotomy. Included were CDs occurring after 24 gestational weeks. CD performed at different centers and indications for repeat surgery unrelated to the primary surgery (e.g., appendicitis) were excluded. Logistic regression was used to adjust for potential confounders. Results: During the study period, 131,268 women delivered at our institution. Of them, 28,280 (21.5%) had a CD, and 130 patients (0.46%) underwent a relaparotomy. Relaparotomies following a CD occurred during the first 24 h, the first week, and beyond the first week, in 59.2%, 33.1%, and 7.7% of cases, respectively. In the multivariable logistic regression analysis, relaparotomy was significantly associated with Mullerian anomalies (aOR 3.33, 95%CI 1.08–10.24, p = 0.036); uterine fibroids (aOR 3.17, 95%CI 1.11–9.05,p = 0.031); multiple pregnancy (aOR 4.1, 95%CI 1.43–11.79,p = 0.009); hypertensive disorders of pregnancy (aOR 3.46, 95%CI 1.29–9.3,p = 0.014); CD during the second stage of labor (aOR 2.54, 95%CI 1.15–5.88, p = 0.029); complications during CD (aOR 1.62, 95%CI 1.09–3.21,p = 0.045); and excessive bleeding during CD or implementation of bleeding control measures (use of tranexamic acid, a hemostatic agent, or a surgical drain) (aOR 2.23, 95%CI 1.29–4.12,p = 0.012). Indications for relaparotomy differed depending on the time elapsed from the CD, with suspected intra-abdominal bleeding (36.1%) emerging as the primary indication within the initial 24 h. Conclusion: We detected several pregnancy, intrapartum, and intra-operative risk factors for the need for relaparotomy following a CD. Practitioners may utilize these findings to proactively identify women at risk, thereby potentially reducing their associated morbidity. [ABSTRACT FROM AUTHOR]

Purpose: In order to spread competence in vaginal breech deliveries, it is necessary to develop new and easily applicable tools for birth progression and safety evaluation. Ultrasound is a useful and ubiquitously available tool with already documented value for birth progression observation. In deliveries out of breech presentation, an established ultrasound examination is missing. We determined the descent of the fetal buttocks in relation to the maternal pelvic inlet using intrapartum ultrasound. We evaluated these results in comparison to the clinical vaginal examination with the aim to establish an easily applicable method for birth outcome prediction. Therefore, we analyzed the predictive value of our examinations on birth outcome parameters, such as cesarean section rate, as well as fetal and maternal outcome parameters. Methods: We performed a prospective blinded study on 106 mothers with vaginally intended breech delivery. At beginning of stage two in labor, the descent of the fetal buttocks into the mother's pelvic inlet was detected with transabdominal ultrasound and vaginal examination by different observers. Primary outcome variable: Cesarean section rate. Secondary outcome variables: rate of manual assistance in vaginal deliveries, birth duration, 5′ APGAR score, umbilical arterial pH, maternal blood loss, and perineal injury. For non-parametric values, Wilcoxon's χ2 test was performed. In order to analyze the predictive value of our examination, lack-of-fit analysis was conducted. Reliability evaluation of the sonographic examination was done with a matched-pair analysis. Results: Women with positive intrapartum ultrasound breech engagement sign (+ IPUBES) had a significantly lower rate of cesarean section in comparison with those with negative IPUBES (5/67; 7.5% vs. 18/39; 46.2%; p < 0.0001). The area under the ROC curve for the prediction of CS for negative IPUBES was 0.765 with a sensitivity of 78.3% and a specificity of 74.7%. Sonographic examination showed an excellent reliability in a matched-pair analysis comparing vaginal and sonographic examinations with a mean difference of 0.012 (SD ± 0.027, 95% CI − 0.014 to 0.065). Mean birth duration was significantly longer in deliveries with negative IPUBES (533 min vs. 440 min; p = 0.0011). Fetal and maternal outcome parameters were not significantly different between deliveries with positive and negative IPUBES. Conclusions: Sonographic evaluation of the fetal descent in relation to the mother's pelvic inlet screens reliably for emergency cesarean section. This newly presented method for birth progression observation might be a powerful tool for distribution of expertise in vaginal breech delivery and is able to give reference for clinical vaginal examination by obstetricians in training. Trail registry: Clinical trial. Date of registration: 13.03.2019; Date of initial participant enrollment: 20.03.2019; DRKS00016885; https://www.drks.de; German clinical trials register. [ABSTRACT FROM AUTHOR]

Assisted vaginal birth rates are falling globally with rising cesarean delivery rates. Cesarean delivery is not without consequence, particularly when carried out in the second stage of labor. Cesarean delivery in the second stage is not entirely protective against pelvic floor morbidity and can lead to serious complications in a subsequent pregnancy. It should be acknowledged that the likelihood of morbidity for mother and baby associated with cesarean delivery increases with advancing labor and is greater than spontaneous vaginal birth, irrespective of the method of operative birth in the second stage of labor. In this article, we argue that assisted vaginal birth is a skilled and safe option that should always be considered and be available as an option for women who need assistance in the second stage of labor. Selecting the most appropriate mode of birth at full dilatation requires accurate clinical assessment, supported decision-making, and personalized care with consideration for the woman's preferences. Achieving vaginal birth with the primary instrument is more likely with forceps than with vacuum extraction (risk ratio, 0.58; 95% confidence interval, 0.39–0.88). Midcavity forceps are associated with a greater incidence of obstetric anal sphincter injury (odds ratio, 1.83; 95% confidence interval, 1.32–2.55) but no difference in neonatal Apgar score or umbilical artery pH. The risk for adverse outcomes is minimized when the procedure is conducted by a skilled accoucheur who selects the most appropriate instrument likely to achieve vaginal birth with the primary instrument. Anticipation of potential complications and dynamic decision-making are just as important as the technique for safe instrument use. Good communication with the woman and the birthing partner is vital and there are various recommendations on how to achieve this. There have been recent developments (such as OdonAssist) in device innovation, training, and strategies for implementation at a scale that can provide opportunities for both improved outcomes and reinvigoration of an essential skill that can save mothers' and babies' lives across the world. [ABSTRACT FROM AUTHOR]

Background and Objectives: Accurate diagnosis of labor progress is crucial for making well-informed decisions regarding timely and appropriate interventions to optimize outcomes for both the mother and the fetus. The aim of this study was to assess the progress of the second stage of labor using intrapartum ultrasound. Material and methods: This was a prospective study (December 2022–December 2023) conducted at the Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece. Maternal–fetal and labor characteristics were recorded, and two ultrasound parameters were measured: the angle of progression (AoP) and the head–perineum distance (HPD). The correlation between the two ultrasonographic values and the maternal–fetal characteristics was investigated. Multinomial regression analysis was also conducted to investigate any potential predictors of the mode of delivery. Results: A total of 82 women at the second stage of labor were clinically and sonographically assessed. The mean duration of the second stage of labor differed between vaginal and cesarean deliveries (65.3 vs. 160 min; p-value < 0.001) and between cesarean and operative vaginal deliveries (160 vs. 88.6 min; p-value = 0.015). The occiput anterior position was associated with an increased likelihood of vaginal delivery (OR: 24.167; 95% CI: 3.8–152.5; p-value < 0.001). No significant differences were identified in the AoP among the three different modes of delivery (vaginal: 145.7° vs. operative vaginal: 139.9° vs. cesarean: 132.1°; p-value = 0.289). The mean HPD differed significantly between vaginal and cesarean deliveries (28.6 vs. 41.4 mm; p-value < 0.001) and between cesarean and operative vaginal deliveries (41.4 vs. 26.9 mm; p-value = 0.002); it was correlated significantly with maternal BMI (r = 0.268; p-value = 0.024) and the duration of the second stage of labor (r = 0.256; p-value = 0.031). Low parity (OR: 12.024; 95% CI: 6.320–22.876; p-value < 0.001) and high HPD (OR: 1.23; 95% CI: 1.05–1.43; p-value = 0.007) were found to be significant predictors of cesarean delivery. Conclusions: The use of intrapartum ultrasound as an adjunctive technique to the standard clinical evaluation may enhance the diagnostic approach to an abnormal labor progress and predict the need for operative vaginal or cesarean delivery. [ABSTRACT FROM AUTHOR]

Objective: Scarce data exist regarding obstetric complications of short‐stature patients. This study aimed to investigate obstetric and perinatal outcomes in women with short stature; specifically, to investigate whether short‐stature patients are at an increased risk for cesarean delivery. Methods: A population‐based cohort study was conducted, including all singletons born between the years 1991 and 2021 at a tertiary medical center. Obstetric and perinatal outcomes of short‐stature patients were compared with those of non‐short patients. A generalized estimation equation binary logistic model was constructed to adjust for confounders and maternal recurrence in the cohort. Results: The study population included 356 356 parturient; among them, 14 035 (3.9%) were short‐stature patients. Short‐stature patients had significantly higher rates of cesarean delivery (20.7% vs 13.7%, odds ratio = 1.64, 95% confidence interval 1.57–1.71, P < 0.001), induction of labor, pathologic presentations, prolonged second stage of labor, non‐reassuring fetal monitoring, and meconium‐stained amniotic fluid. Newborns of short‐stature patients had a significantly higher risk of being small for gestational age as compared with those of non‐short patients. In the generalized estimation equation models, the association between short stature and risk of cesarean delivery remained significant (adjusted odds ratio = 1.32, 95% confidence interval 1.27–1.38, P < 0.001), as well as the risk of small for gestational age newborns (adjusted odds ratio = 1.51, 95% confidence interval 1.40–1.63, P < 0.001), but not for the other adverse outcomes. Conclusions: Maternal short stature is an independent risk factor for cesarean delivery and is associated with small for gestational age newborns. Synopsis: Maternal short stature is an independent risk factor of cesarean delivery and is associated with a higher risk of small for gestational age newborns. [ABSTRACT FROM AUTHOR]

Background: We aimed to evaluate the association of the duration of the second stage with labor after cesarean (LAC) success and other outcomes among women with one prior cesarean delivery (CD) and no prior vaginal births. Methods: All women undergoing LAC that reached the second stage of labor from March 2011 to March 2020 were included in this retrospective cohort study. The primary outcome was the mode of delivery by second stage duration. The secondary outcomes included adverse maternal and neonatal outcomes. We allocated the study cohort into five groups of second stage duration. Further analysis compared <3 to ≥3 h of second stage based on prior studies. LAC success rates were compared. Composite maternal outcome was defined as the presence of uterine rupture/dehiscence, postpartum hemorrhage, or intrapartum/postpartum fever. Results: One thousand three hundred ninety seven deliveries were included. Vaginal birth after cesarean (VBAC) rates decreased as the second stage length time interval increased: 96.4% at <1 h, 94.9% at 1 to <2 h, 94.6% at 2 to <3 h, 92.1% at 3 to <4 h and 79.5% at ≥4 h (p < 0.001). Operative vaginal and CDs were significantly more likely as second stage duration time interval increased (p < 0.001). The composite maternal outcome was comparable among groups (p = 0.226). When comparing the outcomes of deliveries at <3 h versus ≥3 h, the composite maternal outcome and neonatal seizure rates were lower in the <3 h group (p = 0.041 and p = 0.047, respectively). Conclusion: Vaginal birth after cesarean rates decreased as second stage time interval length increased. Even with prolonged second stage, VBAC rates remained relatively high. Increased risk of composite adverse maternal outcomes and neonatal seizures were observed when the second stage lasted 3 h or more. [ABSTRACT FROM AUTHOR]

Epidural analgesia (EA) is an effective and common method of pain relief during labor. However, EA may also have some adverse effects like prolonged labor, increased risk of operative delivery, and some unwanted complications. It's unclear how maternal position affects the outcomes of natural birth with EA. This study aimed to compare mode of delivery and maternal and neonatal outcomes between recumbent and upright positions in nulliparous women with EA. This randomized clinical trial involved 540 women who received EA at cervical dilatation of 4 to 6 cm. During the second stage of labor, they were instructed to adopt upright or recumbent position. The main outcome was the mode of delivery. The secondary outcomes included duration of labor, pain intensity, the Apgar score, and other maternal and neonatal complications. Finally, 528 women were included in the final analysis. The upright group had a higher rate of cesarean section than the recumbent group. The duration of the labor stages did not differ between the groups. The pain intensity in the second stage was higher in the upright position. The Apgar score at 1 and 5 minutes was higher in the recumbent group. There was no difference in terms of other outcomes between the groups. Recumbent positions are beneficial in the case of rate of cesarean, mother's pain, and Apgar score in women with EA. So, adopting a recumbent position during the second stage of labor may be preferable for women with EA. [ABSTRACT FROM AUTHOR]

Aim: To investigate whether the early initiation of neuraxial analgesia prolongs the duration of electively induced labor in Japanese multiparous women. Methods: This retrospective study included multiparous term women who underwent elective induction of labor using combined spinal‐epidural analgesia at the Showa University Hospital between October 2018 and March 2021. The participants were divided into two groups: early and late. If neuraxial analgesia was initiated when the cervical dilation was ≤3 cm, the patient was included in the early group. The remaining patients were included in the late group. The obstetric and neonatal outcomes were compared between the two groups. The primary outcome was the duration of delivery. The secondary outcomes were the rates of instrumental and cesarean deliveries. Results: Two hundred and ninety‐seven women (early group = 139, late group = 158) were included in the analysis. The duration of the first stage of labor did not differ significantly between the early and late groups (median: 232 vs. 260 min, p = 0.35). Similarly, there was no significant difference in the duration of the second stage (37 vs. 40 min, p = 0.20). Moreover, the rates of instrumental and cesarean deliveries did not differ significantly between the groups, and the neonatal outcomes were comparable. Conclusion: Early initiation of neuraxial analgesia in the elective induction of parous Japanese women did not prolong the duration of delivery. Our results suggest that neuraxial analgesia may be initiated whenever a parturient desires it. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effects of extending the second stage of labor in women attempting a trial of labor after a cesarean section (TOLAC). Method: A retrospective cohort study comparing maternal and neonatal outcomes following TOLAC over two periods: period I whose prolonged second stage was considered 2 h, and period II whose prolonged second stage was considered 3 h. The primary outcome was repeat cesarean delivery (CD) rate. Results: Incidence of repeat CD was significantly lower in period II (18.1% vs 29.7%, P < 0.001). Incidence of uterine rupture was significantly higher in period II (P < 0.001). Instrumental delivery rates were significantly higher in period II (26.2% vs 15.6%, odds ratio [OR] 1.67, 95% CI 1.21–3.56, P < 0.001). Rates of third‐ and fourth‐degree perineal lacerations, chorioamnionitis, and length of hospital stay were similar between groups. Incidence of fetal acidemia was significantly higher in period II (1.5% vs 0.7%, OR 2.14, 95% CI 1.32–5.63, P < 0.001), and incidence of neonatal intensive care unit (NICU) admission was significantly higher (2.5% vs 1.6%, P = 0.004). Conclusion: Extension of the second stage of labor is associated with a decrease in repeat CD rate with a concomitant increase in instrumental delivery rates, uterine rupture, fetal acidemia, and NICU admissions. These findings may warrant further consideration of allowing a prolonged second stage in patients attempting TOLAC. Synopsis: Prolongation of the second stage by 1 h is associated with a higher vaginal delivery rate, but an increase in uterine rupture risk was noted. [ABSTRACT FROM AUTHOR]

Trial of labor after cesarean (TOLAC) is an alternative to repeated cesarean for women with singleton pregnancy and one previous transverse lower segment cesarean section (LSCS), resulting in most cases being a successful vaginal birth after cesarean section (VBAC). The primary objective of this study was to examine if the progress and the duration of the active first stage and the second stage of labor in nulliparous women with singleton pregnancy, spontaneous start of labor and vaginal birth differ from primiparous women succeeding VBAC after one previous elective LSCS in a country with a low cesarean section and high VBAC rate. Secondary objectives were to compare labor interventions and maternal–neonatal outcomes between the two groups. Methods: This is a retrospective comparative study. Data were collected in a four-year period at the departments of Obstetrics and Gynecology at Kristianstad and Ystad hospitals in Sweden. Out of 14,925 deliveries, 106 primipara women with one previous elective LSCS and a spontaneous labor onset in the subsequent singleton pregnancy were identified. Of these women, 94 (88.7%) delivered vaginally and were included in the study (VBAC group). The comparison group included 212 randomly selected nulliparous women that had a normal singleton pregnancy, spontaneous labor onset and delivered vaginally. Results: The rate of cervical dilation during the active first stage of labor as well as the duration of the second stage did not differ between the two groups. When adjusting for cervical dilation at admission, there was no significant difference between the two groups regarding the duration of the active phase of the first stage of labor. No significant differences were found in maternal–neonatal outcomes between the two groups except for higher birth weight in the VBAC group. The use of epidural analgesia was associated with slower dilation rhythm over the duration of the active phase and second stage of labor, need for labor augmentation, postpartum bleeding and need for transfusion at higher rates, irrespective of parity when epidural was used. Conclusions: Our study provides evidence that in women with one previous elective LSCS undergoing TOLAC in the subsequent pregnancy resulting in vaginal birth, the progress and duration of labor are not different from those in nulliparous women when labor is spontaneous and the it is a singleton pregnancy. The use of epidural was associated with prolonged labor, need for labor augmentation and higher postpartum bleeding, irrespective of parity. This information may be useful in patient counseling and labor management in TOLAC. [ABSTRACT FROM AUTHOR]

• A shorter BTD is associated with a higher incidence of unplanned obstetrical intervention due to labor dystocia. • There is an inverse correlation between the BTD and the length of the second stage of labor. • Antenatal identification of women at risk for labor dystocia might trigger some specific interventions during the second stage of labor. • Antenatal identification of women at higher risk for labor dystocia might prompt a referral of the patient to a district hospital. The aim our study was to evaluate the association between the antepartum clinical measurement of the Bituberous Diameter (BTD) and the occurrence of unplanned obstetrical intervention (UOI) due to labor dystocia, including either operative vaginal delivery or caesarean section in a cohort of low-risk, nulliparous at term. Retrospective analysis of prospectively collected data. Tertiary maternity care. With the women lying in lithotomic the distance between two ischial tuberosities was assessed using a tape measure during the routine antenatal booking between 37 and 38 weeks of gestation. Overall, 116 patient were included, and of these 23(19.8%) were submitted to an UOI due to labor dystocia. Compared to women that had a spontaneous vaginal delivery, women submitted to an UOI had a shorter BTD (8.25 + 0.843 vs 9.60 + 1.12, p < 0.001), a higher frequency of epidural analgesia (21/23 or 91.3% vs 50/93 or 53.8%; p = 0.002) and of augmentation of labor (14/23 or 60.9% vs 19/93 or 20.4%; p < 0.001) as well as a longer first [455 (IQR 142–455 min vs 293 (IQR 142–455) min] and second stages of labor [129 (IQR 85–155) min vs 51 (IQR 27–78) min]. Multivariable logistic regression showed that the BTD (aOR 0.16, 95% CI 0.04–0.60; p = 0.007) and the length of the second stage of labor (aOR 6.83, 95% CI 2.10–22.23; p = 0.001) were independently associated with UOI. When evaluating the diagnostic accuracy of the BTD for the prediction of UOI due to labor dystocia, the BTD showed an AUC of 0.82 (95 %CI 0.73–0.91; p < 0.001) with an optimal cut-off value of 8.6 cm (78.3% (95 %CI 56.3–92.5) sensitivity, 77.4% (95 %CI 67.6–85.4) specificity, 46.2% (95% CI 30.1–62.8) PPV, 93.5% (95% CI 85.5–97.9) NPV, 3.5 (95% CI 2.3–5.4) positive LR, and 0.28 (95% CI 0.13–0.61) negative LR. A significant inverse correlation between the length of the second stage of labour and the BTD in patients that had a vaginal delivery was also demonstrated (Spearman's rho = -0.24, p = 0.01). Our study suggests that antepartum clinical assessment of the BTD might be used as a reliable predictor of UOI due to labor dystocia in low-risk, nulliparous women at term gestation. Antenatal identification of women at higher risk for labor dystocia might trigger some interventions during the second stage of labor, such as maternal position shifting, to increase the pelvic capacity and potentially improve outcomes or might prompt a referral of the patient to a district hospital prior to the onset of labor. [ABSTRACT FROM AUTHOR]

This document is a reply from the authors of a study published in the BJOG: An International Journal of Obstetrics & Gynaecology. The authors address inquiries and clarify certain points raised by another letter. They explain that their study focused on the prevalence of obstetric anal sphincter injuries (OASIS) in different delivery methods in Norway, and not on the prevalence of the four different delivery methods themselves. They also state that their aim as researchers is to present facts and results, rather than offer direct advice to the international obstetrics and gynecology community. The authors provide additional data on the prevalence of instrumental deliveries and cesarean sections in Norway, and discuss the factors associated with OASIS. They also mention the process of data collection and quality assurance in Norway's Medical Birth Registry. The authors declare no conflicts of interest. [Extracted from the article]

This article, titled "EP19.19: Angle of progression for predicting second-stage Caesarean delivery complications," explores the correlation between the angle of progression (AOP) and maternal surgical complications following a second-stage Caesarean delivery (CD). The study retrospectively evaluated women who underwent CD for arrest of descent at the second stage of labor and found that there was a significant correlation between measured AOP and composite maternal outcome. The authors suggest that assessing AOP before surgery may help identify susceptible cases and allow for appropriate preparation. [Extracted from the article]

This article discusses a study conducted at Kwong Wah Hospital in Hong Kong to analyze the compliance with intrapartum ultrasound examination after implementing an "opt-out" protocol for prolonged second stage of labor. Prior to the protocol, only 29.7% of women received sonographic assessment as directed by the clinician. The study found that after implementing the protocol, the use of intrapartum sonographic assessment increased to 91.1%, while the rate of second stage Caesarean section remained low. The authors conclude that combining clinical and sonographic assessment in the second stage of labor is practical in a general obstetric unit. [Extracted from the article]

Objective: Rare disease Background: Uterine rupture during delivery in an unscarred uterus may be associated with oxytocin dose during second stage arrest and with underlying maternal factors. This report is of a 34-year-old woman, gravida 5, para 3, with no previous history of cesarean section (CS), who had a uterine rupture at term delivery following the use of oxytocin for second-stage arrest. Case Report: A 34-year-old Afghani woman, gravida 5, para 3 was admitted at term for delivery. The current pregnancy had been normal and the estimated birth weight was approximately 4000 g. There was no history of steroid treatment or any underlying connective tissue disease, and no history of dilation and curettage. Oxytocin was given as per protocol, starting at 20 ml/h of a dilution of 10 IU/1 L natrium chloride (NaCl). Subsequent labor progress was complicated by arrest of descent in the second stage of labor, necessitating cesarean section delivery. After opening the abdominal wall, a uterine rupture with several large blood clots was discovered, freely floating in the peritoneal space, about 500 ml in volume. The rupture stretched from the left side of the uterine body and down into the thin lower segment. The tissue in this area had diffuse hematoma. Conclusions: Although uterine rupture mostly occurs in women with previous CS, this report has shown that uterine rupture can occur in pregnancy complicated by arrest in the second stage of labor. [ABSTRACT FROM AUTHOR]

Instrumental vaginal births are performed to speed up the second stage of labour when there are maternal or foetal indications. Trends around the world point to declining instrumental delivery rates. Worldwide, the rate of caesarean sections has increased recently, while instrumental vaginal deliveries have decreased. These patterns might be brought about by worries about maternal and neonatal safety as well as a lack of clinical forceps delivery expertise. A decrease in training hours, a lack of senior supervision, and a fear of lawsuits are a few of the factors contributing to instrumental vaginal delivery being a lost art. Due to these circumstances, it has become more challenging to gain the level of expertise needed for proficiency in this method, which could be dangerous in the hands of an inexperienced or hasty obstetrician. These issues have long been an issue. With an emergency caesarean section, there is a dramatically increased risk of severe obstetric morbidity. Therefore, the right use of instrumental delivery could lower the expenses of obstetric care as well as the hazards related to caesarean sections. A following pregnancy's chances of having a successful spontaneous vaginal delivery are similarly more likely to increase after an instrumental vaginal delivery. [ABSTRACT FROM AUTHOR]

Background: There is conflicting evidence regarding the safety of Kielland's rotational forceps delivery (KRFD) in comparison with other modes of delivery for the management of persistent fetal malposition in the second stage of labour. Objectives: To derive estimates of risks of maternal and neonatal complications following KRFD, compared with rotational ventouse delivery (RVD), non‐rotational forceps delivery (NRFD) or a second‐stage caesarean section (CS), from a systematic review and meta‐analysis of the literature. Search Strategy: Standard search methodology, as recommended by the Cochrane Handbook for Systematic Reviews of Interventions. Selection Criteria: Case series, prospective or retrospective cohort studies and population‐based studies. Data Collection and Analysis: A meta‐analysis using a random‐effects model was used to derive weighted pooled estimates of maternal and neonatal complications. Main Results: Thirteen studies were included. For postpartum haemorrhage there was no significant difference between Kielland's and ventouse delivery; the rate was lower in Kielland's delivery compared with non‐rotational forceps (RR 0.79, 95% CI 0.65–0.95) and second‐stage CS (RR 0.45, 95% CI 0.36–0.58). There were no differences in the rates of anal sphincter injuries or admission to neonatal intensive care. Rates of shoulder dystocia were higher with Kielland's delivery compared with ventouse delivery (RR 1.79, 95% CI 1.08–2.98), but rates of neonatal birth trauma were lower (RR 0.49, 95% CI 0.26–0.91). There were no differences seen in the rates of 5‐min APGAR score < 7 between Kielland's delivery and other instrumental births, but they were lower when compared with second‐stage CS (RR 0.47, 95% CI 0.23–0.97). Conclusions: Kielland's rotational forceps delivery is a safe option for the management of fetal malposition in the second stage of labour. Linked article: This article is commented on by Parris and Siassakos, pp. 865 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471-0528.17413. [ABSTRACT FROM AUTHOR]

Background: Prolonged 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. Methods: A 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). Results: Each 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. Conclusions: As 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. [ABSTRACT FROM AUTHOR]

Objective: To assess the correlation between the total decelerations area in the final 120 min before delivery and neonatal cord blood pH in postdate pregnancies. Methods: This cross‐sectional study included women with gestational age greater than 41 weeks, singleton pregnancy, and a category II electronic fetal monitoring (EFM) of at least 30 min during the final 120 min before delivery. We included postdate deliveries of an otherwise low‐risk parturient population. Each area was calculated as duration × depth × 1/2. Correlations were tested using the Spearman correlation coefficient. Results: A total of 100 EFMs were included in the analysis. Median pH was significantly lower in neonates above the median total deceleration area under the curve (AUC; 7.26 vs. 7.32, P = 0.002). Gestational age at delivery was independently associated with total deceleration AUC above median (adjusted odds ratio 1.21, 95% confidence interval 1.09–1.37) controlling for history of previous cesarean delivery and duration of second stage of labor. A significant correlation was found between cord blood pH and total deceleration area (P < 0.001, Spearman correlation coefficient −0.37). Conclusion: Among women with postdate pregnancies, the total deceleration area and the mean maximum duration of decelerations were negatively correlated with cord blood pH. Further studies are needed to incorporate deceleration area as a method in predicting fetal acidemia. Synopsis: Total deceleration area and the mean maximum duration of decelerations are negatively correlated with cord blood pH among women with postdate pregnancies. [ABSTRACT FROM AUTHOR]

Nulliparous women have similar cesarean delivery rates in the second stage of labor when using the Zhang compared with the Friedman labor curve. OBJECTIVE: To estimate the cesarean delivery rate in the second stage of labor in nulliparous women when using the Zhang compared with the Friedman labor curve by performing a systematic review and meta-analysis. DATA SOURCES: We explored MEDLINE, EMBASE, Web of Science, CINAHL (Cumulative Index to Nursing and Allied Health Literature), ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials for studies comparing the cesarean delivery rate in the second stage of labor in nulliparous women when using the Zhang compared with the Friedman labor curve. METHODS OF STUDY SELECTION: Two reviewers separately ascertained studies, obtained data, and gauged study quality. The cesarean delivery rate was compared, and odds ratios (ORs) with 95% CIs were estimated. TABULATION, INTEGRATION, AND RESULTS: Five retrospective cohort studies and two randomized controlled trials were identified with 20,165 nulliparous women (10,861 with the Zhang labor curve vs 9,304 with the Freidman labor curve). Studies evaluated women with delivery from June 2010 to May 2017. Two studies were from the United States; two were from Israel; and one each was from China, France, and Norway. The median point prevalence of cesarean delivery in the second stage was 4.0% (95% CI 2.1–14.5%) in cases managed with the Zhang labor curve compared with 5.6% (95% CI 1.8–28.6%) in cases managed with the Friedman labor curves. The overall cesarean delivery rate in the second stage of labor was similar when the Zhang labor curve compared with the Friedman labor curve was used (pooled OR 0.86, 95% CI 0.47–1.57, I 2=93%). When the two randomized controlled trials were excluded, the results of the cohort studies continued to demonstrate that the overall cesarean delivery rate in the second stage of labor was similar (pooled OR 0.84, 95% CI 0.42–1.69, I 2=92%). CONCLUSION: Nulliparous women have similar cesarean delivery rates in the second stage of labor when either the Zhang or Friedman labor curve is used. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42022346425. [ABSTRACT FROM AUTHOR]

Introduction: Cesarean delivery carries both short term and long-term maternal complications. Eventhough it's being a public burden, the proportion of complications and underlying risk factors are not studied well in our setup. This study aimed to assess the proportion and associated factors of complications of cesarean sections among mothers who delivered at Bahir Dar city public specialized hospitals, Bahir Dar, Ethiopia 2021. Methods: A cross-sectional study was conducted at two specialized Hospitals in Bahir Dar city, Ethiopia. The sample size was 495 mothers who had cesarean section in the time period from January 1, 2020 to December 30, 2020. Checklist was used to retrieve information from the patient medical document. Study population was selected from the operation registration book. Systematic sampling was used after arranging the study frame based on date of operation. Both bivariable and multivariable logistic regression was done. In multivariable logistic regression variables with p value < 0.05 at 95% confidence interval were significantly associated with outcome variable. Result: Overall maternal complication rate was 44.04% (95% CI: 39.6–48.5). Living in rural setting (AOR = 4.247,95%CI: 2.765–6.522), having one or more obstetric complication (AOR = 1.913,95% CI: 1.214–3.015), cesarean section done at Second stage of labor (AOR = 4.358,95%CI: 1.841–10.317), having previous cesarean section (AOR = 3.540,95%CI: 2.121–5.910), emergency operation (AOR = 2.967,95%CI: 1.492–5.901), duration of surgery taking more than 60 min (AOR = 3.476,95%CI: 1.521–7.947) were found to be significantly associated with maternal complications. Conclusion: The magnitude of maternal complication of cesarean section was higher than most studies. Living in rural setting, having obstetric complications, previous cesarean scar, emergency surgeries, operation done in second stage of labor and prolonged duration of surgery are important predictors of maternal complication. Therefore, we recommend timely and adequate progress of labor evaluation, timely decision for cesarean delivery and vigilant care in post-operative period shall be conducted. [ABSTRACT FROM AUTHOR]

Background: Prolonged second stage of labour is an important cause of maternal and perinatal morbidity and mortality. Vacuum extraction (VE) and second‐stage caesarean section (SSCS) are the most commonly performed obstetric interventions, but the procedure chosen varies widely globally. Objectives: To compare maternal and perinatal morbidity, mortality and other adverse outcomes after VE versus SSCS. Search Strategy: A systematic search was conducted in PubMed, Cochrane and EMBASE. Studies were critically appraised using the Newcastle–Ottawa scale. Selection Criteria: All artictles including women in second stage of labour, giving birth by vacuum extraction or cesarean section and registering at least one perinatal or maternal outcome were selected. Data Collection and Analysis: The chi‐square test, Fisher exact's test and binary logistic regression were used and various adverse outcome scores were calculated to evaluate maternal and perinatal outcomes. Main Results: Fifteen articles were included, providing the outcomes for a total of 20 051 births by SSCS and 32 823 births by VE. All five maternal deaths resulted from complications of anaesthesia during SSCS. In total, 133 perinatal deaths occurred in all studies combined: 92/20 051 (0.45%) in the SSCS group and 41/32 823 (0.12%) in the VE group. In studies with more than one perinatal death, both conducted in low‐resource settings, more perinatal deaths occurred during the decision‐to‐birth interval in the SSCS group than in the VE group (5.5% vs 1.4%, OR 4.00, 95% CI 1.17–13.70; 11% vs 8.4%, OR 1.39, 95% CI 0.85–2.26). All other adverse maternal and perinatal outcomes showed no statistically significant differences. Conclusions: Vacuum extraction should be the recommended mode of birth, both in high‐income countries and in low‐ and middle‐income countries, to prevent unnecessary SSCS and to reduce perinatal and maternal deaths when safe anaesthesia and surgery is not immediately available. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of SLK triple therapy combined with epidural labor analgesia on pelvic floor function and perinatal outcome of primipara. Methods: 200 pregnant women who delivered singleton in Jiangyin People’s Hospital and its group hospitals from January 2022 to December 2022 were selected and randomly divided into control group, SLK triple therapy group,epidural delivery analgesia group and combined group according to random number table, with 50 cases in each group. The control group received routine training, the SLK triple therapy group received Sopfrology delivery training, Lamaze breath training and Kegel training,the epidural delivery analgesia group received patient controlled epidural analgesia, and the combined group received epidural delivery analgesia on the basis of SLK triple therapy. The pelvic floor function indexes were detected by ultrasonic diagnostic instrument(2) The pelvic floor electrophysiological indexes were detected by neuromuscular stimulation biofeedback therapeutic instrument, and the prenatal fever rate, midwifery rate, postpartum hemorrhage rate, cesarean section rate, labor process and Apgar score were recorded and compared in each group. Results: Compared with the control group, the pelvic floor ultrasonic examination △ y α, β, γ There was no significant difference among the parameters(P＞0.05); Pelvic floor ultrasonic examination △ y α, β, γ All the parameters were significantly lower than those in the control group(P＜0.05); However, there was no significant difference between SLK group and combination group in the above indicators(P＞0.05). The muscle strength of class Ⅰand class Ⅱ muscle fibers and fatigue of class Ⅰ and class Ⅱ muscle fibers in SLK group and combination group were significantly better than those in the control group(P＜0.05); However, there was no significant difference between SLK group and combination group in the above indicators(P＞0.05). The postpartum hemorrhage rate and cesarean section rate in SLK group, epidural analgesia group and combination group were significantly lower than those in the control group(P＜0.05), the first and second stages of labor in epidural analgesia group were significantly higher than those in the control group(P＜0.05), the first and second stages of labor in SLK group were significantly lower than those in the control group, and the first and second stages of labor in combination group were significantly lower than those in epidural analgesia group, Apgar score of SLK group and combined group was significantly higher than that of control group. Conclusion: SLK triple therapy combined with epidural labor analgesia can effectively improve the pelvic floor function and perinatal outcome of primipara, and make up for the shortage of epidural labor analgesia alone, which is worthy of clinical promotion. [ABSTRACT FROM AUTHOR]

Background: Caesarean sections (CS) account for 26% of all births in the UK, of which at least 5% are done at full dilatation, in the second stage of labour. Second stage CS may be complicated by the fetal head being deeply impacted in the maternal pelvis, requiring specialist skills to achieve a safe birth. Numerous techniques are used to manage impacted fetal head, however, there are no national clinical guidelines in the UK. Aim: To explore health professionals' and women's views on the acceptability and feasibility of a randomised controlled trial (RCT) designed to explore approaches to managing an impacted fetal head during emergency CS. Methods: Semi-structured interviews with 10 obstetricians and 16 women (6 pregnant and 10 who experienced an emergency second stage CS). Interviews were transcribed and analysed using systematic thematic analysis. Results: The findings considered the time at which you obtain consent, how and when information about the RCT is presented, and barriers and facilitators to recruiting health professionals and women into the RCT. Obstetricians emphasised the importance of training in the techniques, as well as the potential conflict between the RCT protocol and current site or individual practices. Women said they would trust health professionals' to use the most appropriate technique and abandon the RCT protocol if necessary. Similarly, obstetricians raised the tension between the RCT protocol versus safety in reverting to what they knew under emergency situations. Both groups reflected on how this might affect the authenticity of the results. A range of important maternal, infant and clinical outcomes were raised by women and obstetricians. However, there were varying views on which of the two RCT designs presented to participants would be preferred. Most participants thought the RCT would be feasible and acceptable. Conclusions: This study suggests an RCT designed to evaluate different techniques for managing an impacted fetal head would be feasible and acceptable. However, it also identified a number of challenges that need to be considered when designing such an RCT. Results can be used to inform the design of RCTs in this area. [ABSTRACT FROM AUTHOR]

Purpose: To determine the validity of intrapartum ultrasound (IPUS), and particularly the angle of progression (AOP), in predicting delivery mode when measured in real-life clinical practice among women with protracted second stages of labor. Methods: Using electronic medical records, nulliparous women with a second stage of labor of ≥ 3 h ("prolonged") and a documented AOP measurement during the second stage were identified. The ability of a single AOP measurement in "prolonged" second stage to predict a vaginal delivery (VD) was assessed. Fetal head descent, measured by AOP change/h (calculated from serial measurements), was compared between women who delivered vaginally and those who had a cesarean delivery (CD) for arrest of descent. Results: Of the 191 women who met the inclusion criteria, 62 (32.5%) delivered spontaneously, 96 (50.2%) had a vacuum extraction (VE) and 33 (17.3%) had a CD. The mean AOP was wider among women who had VD (spontaneous or VE) compared to those who had CD (153° ± 19 vs. 133° ± 17, p < 0.001). Wider AOPs were associated with higher rates of VD and an AOP ≥ 127° was associated with a VD rate of 88.6% (148/167). Among the 87 women who had more than one AOP measurement, the mean AOP change per hour was higher in the VD group than in the CD group (15.1° ± 11.4° vs. 6.2° ± 6.3°, p < 0.001). Conclusion: Ultrasound-assessed fetal head station in nulliparous women with a protracted second stage of labor can be an accurate and objective additive tool in predicting the mode and interval time to delivery in real-life clinical practice. [ABSTRACT FROM AUTHOR]

Background. Obstetric hemorrhage is a frequent and life-threatening complication of either vaginal or cesarean delivery. It can be due to many causes, one of which is placenta accreta, the abnormal invasion of the placenta into the myometrial wall of uterus. Ultrasonography is the first line diagnostic method that can lead to the diagnosis of placenta accreta although, the depth of penetration is estimated by magnetic resonance imaging. Placenta accreta is a life-threatening situation requiring an experienced health care team for its management. Hysterectomy is usually performed although, conservative management might be preferred in carefully selected cases. Case Presentation. A 32-year-old woman (G2, P0) who had an inconsistently monitored pregnancy appeared at a regional hospital with contractions at 39th week of gestation. In her first pregnancy, she was subjected to cesarean section due to delay in second stage of labor and unfortunately her child died due to sudden cardiac death. During C-section, placenta accreta was identified. Given her previous history and her desire to maintain fertility, conservative management was initially planned to preserve her uterus. However, due to persisting vaginal bleeding immediately after delivery an emergency hysterectomy was performed. Conclusion. Conservative management of placenta accreta can be considered in some special cases with the aim to spare fertility. However, if bleeding cannot be controlled during the immediate postpartum period, emergency hysterectomy is unavoidable. A specialized multidisciplinary medical team is required to optimize management. [ABSTRACT FROM AUTHOR]

Objective: To investigate the mode of delivery and birth outcomes in relation to the duration of the passive second stage of labour in nulliparous women. Methods and findings: A retrospective cohort study of all nulliparous women (n = 1131) at two delivery units in Sweden. Maternal and obstetric data were obtained from electronic medical records during 2019. The passive second stage was defined as the complete dilation of the cervix until the start of the active second stage. The duration of the passive second stage was categorized into three groups: 0 to 119 min (0 to <2 h), 120–239 min (2- <4h) and ≥240 min (≥4h). Differences between the groups were examined using t-test and Chi2-tests and regression analyses were used to analyse adjusted odds ratio with 95% confidence intervals. The primary outcome was mode of delivery in relation to the duration of the passive second stage and the secondary outcomes covered a series of adverse maternal and neonatal birth outcomes. The rates of instrumental and caesarean deliveries increased as the duration of the passive second stage increased. A ≥4-hour duration of the passive second stage was associated with a nine-times increased risk of caesarean section, and a four-times risk of instrumental delivery compared to a duration of <2 hours in the adjusted analyses. No differences were found in the maternal birth outcomes. The risk of a 5-minute Apgar score <7 was increased in the 2-<4h group. A longer passive second stage was not associated with an increased risk of negative birth experience. Conclusions: Our study demonstrates an increased risk of operative delivery for a longer duration (>2h) of the passive second stage in nulliparous women, although most of the women gave birth by spontaneous vaginal delivery even after ≥4 hours. There was no evidence of an increased risk of adverse maternal outcomes in a longer duration of the passive second stage but there were indications of increased adverse neonatal outcomes. Assessment of fetal well-being is important when the duration of the passive phase is prolonged. [ABSTRACT FROM AUTHOR]

Background: Intrapartum care is of paramount importance in overall respectful maternity care (RMC). Uterine fundal pressure maneuver (UFPM) is the most controversial obstetric maneuver considered obsolete in many countries. UFPM is associated with adverse life threatening maternal and fetal effects. The baseline prevalence of UFPM in our tertiary care teaching hospital with a heavy patient load was 78.4% which was quite high. Our aim was to reduce the prevalence of UFPM by 75% from baseline over a period of 10 months. Methods: After root cause analysis, we formulated the departmental Standard Operating Procedures on safe vaginal delivery and birth practices and initiated the Labour Room Quality Improvement Initiative. We sensitized and created awareness among the resident doctors and nursing staff regarding the high prevalence of UFPM through dedicated lectures, intercommunication via WhatsApp groups and strict vigilance in the labor wards. The point of care quality improvement (QI) methodology was used. The primary outcome was decrease in the prevalence of UFPM. Results: The prevalence of UFPM reduced from the baseline value of 78.4%–4% over the period of 7 months. Post intervention it gradually increased and sustained at 21.2% over a follow‐up period of 3 months. Conclusion: QI methods can effectively and rapidly improve the acceptance and adherence to newer initiatives in a busy tertiary care health facility to reduce the prevalence of UFPM and eventually improve the overall RMC. [ABSTRACT FROM AUTHOR]

Introduction: Maternal pushing techniques during the second stage of labor may affect women's pelvic floor function. Our main objective was to assess the impact of the type of pushing used at delivery on the mother's medium‐term pelvic floor function. Material and methods: This is a secondary analysis of a randomized clinical trial (clinicaltrials.gov: NCT02474745) that took place in four French hospitals from 2015 through 2017 (n = 250). Women in labor with a singleton fetus in cephalic presentation at term who had undergone standardized training in both of these types of pushing were randomized after cervical dilation ≥7 cm. The exclusion criteria were a previous cesarean, a cesarean delivery in this pregnancy or a fetal heart rate anomaly. In the intervention group, open‐glottis (OG) pushing was defined as a prolonged exhalation contracting the abdominal muscles to help move the fetus down the birth canal. Closed‐glottis (CG) pushing was defined as Valsalva pushing. The principal outcome was the stage of pelvic organ prolapse (POP) assessed by the Pelvic Organ Prolapse‐Quantification 2 months after delivery. A secondary outcome was incidence of urinary incontinence (UI). The results of our multivariable, modified intention‐to‐treat analysis are reported as crude relative risks (RRs) with their 95% confidence intervals. Results: Our analysis included 207 women. Mode of birth was similar in both groups. The two groups did not differ for stage II POP: 10 of 104 (9.4%) in the OG group compared with 7 of 98 (7.1%) in the CG group, for a RR 1.32, 95% confidence interval [CI] 0.52–3.33, and an adjusted RR of 1.22, 95% CI 0.42–3.6. Similarly, the incidence of UI did not differ: 26.7% in the OG group and 28.6% in the CG group (aRR 0.81, 95% CI 0.42–1.53). Subgroup analysis suggests that for secundiparous and multiparous women, OG pushing could have a protective effect on the occurrence of UI (RR 0.33, 95% CI 0.13–0.80). Conclusions: The type of directed pushing used at delivery did not impact the occurrence of pelvic organ prolapse 2 months after delivery. OG pushing may have a protective effect against UI among secundiparous and multiparous women. [ABSTRACT FROM AUTHOR]

Objective: The objective was to assess the predictive value of head-perineum distance measured at the initiation of the active second stage of labor on the mode of delivery.Material and Methods: It was a prospective cohort study in an academic Hospital of Rennes, France, from July 1, 2020 to April 4, 2021 including 286 full-term parturients who gave birth to a newborn in cephalic presentation. A double-blind ultrasound measurement of the head-perineum distance was performed during the second phase of labor within five minutes after the onset of pushing efforts. The primary outcome was the mode of delivery (spontaneous vaginal delivery versus instrumental vaginal delivery or cesarean section). We performed a multivariate analysis to determine the predictive value of the head-perineum distance by adjusting on potential confounders.Results: Overall, 199 patients delivered by spontaneous vaginal delivery, 80 by instrumental vaginal delivery, and seven by cesarean section. The head-perineum distance measured at the beginning of pushing efforts was predictive of the mode of delivery with a threshold at 44 mm (crude: sensitivity = 56.8 % and specificity = 79.3 %; adjusted: sensitivity = 79.4 % and specificity = 87.4 %). The risk of medical intervention was higher when the head-perineum distance is>44 mm with an adjusted OR of 2.78 [1.38; 5.76].Conclusion: The head-perineum distance measured at the initiation of the active second stage of labor is predictive of the mode of delivery. Head-perineum distance below 44 mm predicts a vaginal delivery with the best diagnostic performance, and optimizes the time to start pushing efforts. [ABSTRACT FROM AUTHOR]

To identify risk factors, maternal and neonatal adverse outcomes related to unintended lower segment uterine extension during cesarean delivery (CD). A retrospective cohort analysis in a single, university-affiliated medical center between 1 January 2018 and 31 December 2019. All singleton pregnancies delivered by CD were included. Univariate and multivariate analyses were performed to identify maternal and obstetrical predictors for uterine extension during CD. For secondary outcomes, we assessed the correlation between uterine extension and any adverse maternal or neonatal outcome. Risk factors were analyzed using ROC statistics to measure their prediction performance for a uterine extension. Overall, 1746 (19.3%) CDs were performed during the study period. Of them, 121 (6.9%) CDs were complicated by unintended uterine extension. There was no difference in maternal demographics and clinical data stratified by uterine extension at CD. Uterine extensions were significantly more common following induction of labor, intrapartum fever, premature rupture of membranes, a trial of labor after cesarean, advanced gestational age, emergent CD, and in particular CD during the second stage of labor (37.2% vs. 6.5%) and after failed vacuum extraction (6.6% vs. 1.1%), p <.05 for all. The incidence of postpartum hemorrhage and re-laparotomy did not differ between the groups. Most of the extensions were caudal-directed (40.4%), and were closed by a two-layer closure (92%). Mean extension size was 4.5 ± 1.7 cm. Using multivariable analysis, the only factor that remained significant was CD at the second stage of labor (adjusted odds ratio (aOR) 54.2, 95% CI 4.5–648.9, p =.002), with an area under the ROC curve 0.653 (95% CI 0.595–0.712, p <.001). Emergent CD, body mass index, birth weight, failed vacuum attempt, and trial of labor after cesarean were not significant. For secondary outcomes, an unintended uterine extension was associated with longer operation time, higher estimated blood loss, greater pre- to post-CD hemoglobin difference, increased blood products transfusion, puerperal fever, and longer hospital stay. No clinically significant neonatal adverse outcomes were observed. In our cohort, second-stage CD was the strongest predictor for an unintended uterine extension. Following uterine extension, women had increased infectious and blood-loss morbidity. [ABSTRACT FROM AUTHOR]

To assess factors associated with spontaneous rotation in the occiput anterior position for fetuses in persistent occiput posterior (OP) during the second stage of labor. To evaluate maternal and fetal outcomes after spontaneous rotation of persistent OP. This is a prospective cohort of 495 women with fetuses in persistent OP position, confirmed with ultrasonography during the second stage of labor. We performed simple logistic regressions, followed by multiple logistic regressions. Among 495 women with fetuses in persistent OP position, 78 fetuses (16%) underwent a spontaneous rotation during the second stage of labor. The multivariate analysis found that a short duration of the first stage of labor (<7 h) was associated with a spontaneous rotation of the fetal head in the second stage of labor (OR 0.43 [0.23; 0.76. There were fewer episiotomies (25.6% vs 52.3%, p <.01), cesarean sections (0% v. 5.4%, p =.03), and instrumental deliveries (8.9% vs. 50%, p <.01) in the "spontaneous rotation" group, and the two groups were similar regarding post-partum hemorrhage. The newborns in the "spontaneous rotation" group had a higher Apgar score at 1 min (10 v. 9, p =.02). The two groups did not differ for other neonatal parameters, such as arterial pH value, Apgar score at 5 min, birth trauma, or transfer into the pediatric unit. A shorter duration of the first stage of labor (< 7 h) is a predictive factor of spontaneous rotation in the occiput anterior position for fetuses in persistent OP position. A spontaneous rotation in case of an OP position is associated with better maternal and fetal outcomes. [ABSTRACT FROM AUTHOR]

The objectives of this study were to determine in a population-based cohort study the association between cesarean section (CS) during the second stage of labor and the risk for preterm birth and/or cervical insufficiency in the subsequent pregnancy; to identify maternal and neonatal risk factors for long-term complications following CS due to prolonged second stage of labor. We conducted a retrospective population-based cohort study including women who had at least one consecutive delivery following a CS at our institution from 1991 to 2018, provided that the first delivery was at term. We divided the study cohort into two groups: (1) women who delivered by CS due to failure to progress during the first stage of labor (n = 1068); and (2) those who delivered by CS due to arrest of descent at the second stage of labor (n = 603). Of the 120,147 women who met the inclusion criteria, 78,407 had a subsequent delivery during the study period. Women of group 1 were significantly older than those of group 2 (p =.018), and had a higher rate of assisted reproductive technology [61 (5.7%) vs. 18 (3.1%), p <.022,]. Additionally, their hospitalization period was significantly longer (p <.001). The rate of preterm birth in the subsequent delivery was higher among women who had a CS due to arrest of descent than those who had a CS due to arrest in dilatation [43 (7.3%) vs 49 (4.6%), p <.026]. This was confirmed after adjusting for confounding factors In a multivariable regression analysis (OR 1.78, 95% CI 1.14–2.76, p value =.011) A Cox regression analysis implying gestational age at delivery at the time factor identifies CS due to arrest of descent as a risk factor for subsequent preterm birth (Hazard ratio 1.19 95% CI 1.07–1.31). CS due to arrest of descent is an independent risk factor for subsequent preterm birth. The exact mechanisms contributing to this association are yet to be determined. Cesarean section during the second stage of labor is an independent risk factor for late preterm birth in the subsequent pregnancy when compared to cesarean section in the first stage of labor. [ABSTRACT FROM AUTHOR]

Preterm delivery is greatly associated with perinatal mortality and morbidity, while there is no objective way to identify high-risk newborns currently. This study aimed at discovering the risk factor for Apgar score less than 7 at 1 minute of preterm neonates born with vaginal delivery. A retrospective study was performed in single pregnancy women with a vaginal delivery before 37 weeks of gestation. All the preterm infants were categorized into three types: very preterm birth (28 to 32 weeks), moderate preterm birth (32 to 34 weeks) and late preterm birth (34 to 37 weeks). Risk factors were identified through logistic regression analysis in every category of newborns mentioned above. And the receiver operating characteristic analysis was used in continuous variables to determine the best threshold of the outcome. On the basis of the selected factors, the predicting models are created and its prognosticating ability is compared by the area under the curve. A nomogram was established for the proved best model. A total of 981 cases were investigated, of whom 55 were found with 1 min Apgar scores less than 7. The nomogram was set for the predicting model with larger area under the receiver operating characteristic curve, of which is 0.742(95% confidence interval = 0.670–0.805) in very preterm birth, with the variables of first and second labor stage(> = 1.6 hours), birthweight and MgSO4(magnesium sulfate), and is 0.807(95% confidence interval = 0.776–0.837) in late preterm birth, with the variables of second labor stage(> = 1.23 hours), birthweight, a history of previous cesarean delivery, fetal distress and placental abruption. The combination of first and second labor stage, newborn weight and MgSO4 use can predict 74.2% of 1 minute Apgar score < 7 in very preterm neonates. And 80.7% high-risk infants can be identified when second labor stage, newborn weight, VBAC (vaginal birth after cesarean) and the occur of placental abruption and fetal distress were combined in the predicting model for late preterm birth. These predicting models would bring out great assistance towards obstetricians and reduce unnecessary adverse fetal outcomes. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association of the timing of primary cesarean delivery with the progress of labor and the operative delivery rate at the subsequent successful trial of labor. Methods: A retrospective study of women with a primary cesarean and subsequent term cephalic vaginal delivery in two medical centers. Cesarean deliveries were classified as planned, intrapartum first stage or intrapartum second stage. The second stage duration and the operative delivery rate, adjusted to epidural analgesia and oxytocin use, were compared between the groups. χ² and Kruskal–Wallis tests were used for analysis of categorical and continuous variables, respectively. Results: The study population included 1166 women. The second stage of labor was longer when the previous cesarean delivery occurred during the second stage compared to planned or first stage (1.7 h vs 1.3 h vs 1.3 h, p = 0.005). The proportion of operative deliveries was greater among women with previous cesarean in the second stage of labor (39.6%), compared to planned (26.9%) or first stage (28.8%), p = 0.006. Conclusion: Cesarean delivery at the second stage of labor is associated with a longer second stage and an increased operative delivery rate at the subsequent vaginal birth. Our findings attest to the delicate passenger-passage relations that can exist in some parent-couples. [ABSTRACT FROM AUTHOR]

Purpose of the article: Cesarean rates and maternal morbidity increase with the duration of the second stage of labor. We studied the effect of hourly evaluation and documentation during the second stage of labor on maternal and fetal outcomes. Materials and methods: We performed a retrospective cohort study of all women who delivered at our urban, tertiary care hospital and underwent a second stage of greater than 60 min between 1 June 2016 and 31 May 2019. There were 1498 patients with complete data. Four hundred forty patients had hourly evaluation and documentation throughout the second stage and 1058 did not. We performed t-tests, Chi-squared, and regression analyses to compare cesarean delivery rate, second-stage duration, quantitative blood loss, hemorrhage and blood transfusion rates, and fetal outcomes. We performed regression analyses to evaluate for independent effect of this intervention on each outcome. Results: Patients with hourly evaluation and documentation had a decreased likelihood of cesarean delivery (8.2% vs. 20.3%, p < .001), shorter second-stage of labor (98.1 min vs. 177.5 min, p < .001), decreased quantitative blood loss (514.4 mL vs. 667.7 mL, p < .001), and hemorrhage rate (12.5% vs. 19.9%, p < .001). Hourly evaluation was associated with decreased transfusion rates (3.2% vs. 5.6%, p = .05) but was not related to the number of units transfused. Regression analyses confirmed the impact of hourly documentation when potential confounders were included. These differences in outcomes were also noted when evaluation was performed and documented within every 75 min. Hourly second-stage evaluation and documentation did not affect other maternal or infant morbidities. Conclusion: Hourly evaluation and documentation in the second stage was associated with decreased cesarean delivery rate, second-stage duration, quantitative blood loss, hemorrhage, and transfusion. [ABSTRACT FROM AUTHOR]

Objective: To examine the association between actual birth weight difference of more than 1000 g between the second and first delivery and short-term maternal and neonatal outcomes including mode of delivery. Methods: Retrospective database cohort study of single large academic center, between the years 2005 and 2019. Study population included all women who had their first and second live fetus singleton delivery in our center. Women who had cesarean delivery at first delivery were excluded. Primary outcome was mode of delivery in second delivery. Secondary outcomes were composite adverse maternal and neonatal outcomes. Univariate analysis was followed by multivariate logistic regression. Results: A total of 22,751 women were included. Of those, 316 (1.4%) gave birth to neonates with inter-delivery birth weight interval ≥1000 g from their first delivery. Women in the study group had higher rates of Oxytocin augmentation of labor, longer first and second stages of labor, episiotomy, vacuum extraction, shoulder dystocia and 1-min Apgar score ≤7. Cesarean delivery was more prevalent among the study group (7.9% vs 3.2%, aOR 3.31 [1.78–6.17], p < .001), including in-labor cesarean delivery (3.2% vs 1.5%, aOR 2.97 [1.46–6.06], p = .01) as were the composite adverse maternal and neonatal outcomes – (12.7% vs 8.4%, aOR 1.69 [1.20–2.38], p < .01), and (15.5% vs 11,9% aOR 1.95 [1.40–2.72], p < .001), respectively. Conclusion: Birth weight interval ≥1000 g is associated with higher rates of cesarean deliveries, as well as an increase in maternal and neonatal adverse outcomes, making it worthwhile to screen women for significant birth weight differences. [ABSTRACT FROM AUTHOR]

Objective In 2014, the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal Fetal Medicine (SMFM) published an Obstetric Care Consensus for safe prevention of primary cesarean delivery. We aimed to assess whether these guidelines decreased the primary CD rate during the second stage of labor, in our department. Design, setting, and population A retrospective cohort study of all women reaching the second stage of labor, at term, in a single university-affiliated medical center between2010 and 2017. Methods We compared maternal and neonatal outcomes over three year’s periods:-pre-guidelines (2010–2013) vs. 2nd period – post-guidelines (2014–2017). The main outcome measures CD rate at 2ndstage of labor. Results The study included 11,464 women. The CD rate in the 2nd stage of labor has increased significantly from 4% to 5.9% in the post-guidelines period (OR 1.48, 95% CI 1.16–1.89, p = .001). After a sub-analysis of specific subgroups, and adjustment for confounders, the increase was solely observed in nulliparous women (aOR 1.418, 95% CI 1.067–1.885, p = .016). Furthermore, increased odds for vaginal operative delivery were observed in the multiparous women in the post-guidelines period (2.7% vs. 4.1%, p = .046). Conclusions The implementation of the new ACOG and SMFM guidelines was not associated with a change in the CD rate performed at the 2nd stage of labor in the whole study population. However, there was a rise in the CD rate performed at the 2nd stage in nulliparous women. Furthermore, there was an increase in operative deliveries in the whole study population, especially in multiparous women, without an apparent increase in other immediate adverse neonatal or maternal outcomes. [ABSTRACT FROM AUTHOR]

Objective: To explore the duration of the active phase of the second stage of labour in relation to maternal pre‐pregnant body mass index (BMI). Design: Retrospective cohort study. Setting: Labour wards of three Norwegian university hospitals, 2012–2019. Population: Nulliparous and parous women without previous caesarean section with a live singleton fetus in cephalic presentation and spontaneous onset of labour, corresponding to the Ten Group Classification System (TGCS) group 1 and 3. Methods: Women were stratified to BMI groups according to WHO classification, and estimated median duration of the active phase of the second stage of labour was calculated using survival analyses. Caesarean sections and operative vaginal deliveries during the active phase were censored. Main outcome measures: Estimated median duration of the active phase of second stage of labour. Results: In all, 47 942 women were included in the survival analyses. Increasing BMI was associated with shorter estimated median duration of the active second stage in both TGCS groups. In TGCS group 1, the estimated median durations (interquartile range) were 44 (26–75), 43 (25–71), 39 (22–70), 33 (18–63), 34 (19–54) and 29 (16–56) minutes in BMI groups 1–6, respectively. In TGCS group 3, the corresponding values were 11 (6–19), 10 (6–17), 10 (6–16), 9 (5–15), 8 (5–13) and 7 (4–11) minutes. Increasing BMI remained associated with shorter estimated median duration in analyses stratified by oxytocin augmentation and epidural analgesia. Conclusion: Increasing BMI was associated with shorter estimated median duration of the active second stage of labour. This article includes Author Insights, a video abstract available at https://vimeo.com/bjogabstracts/authorinsights17186. Linked article This article is commented on by Whitney A. Booker, pp. 2175 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471‐0528.17185 [ABSTRACT FROM AUTHOR]

Objective: To evaluate the risk of spontaneous preterm birth on subsequent pregnancies after second stage cesarean section. Methods: This is a retrospective cohort study. Women were included if they had their two consecutive births in Toulouse University Hospital in the study period. The first birth was a singleton livebirth at term (≥37 weeks of gestation), divided in three categories according to the mode of delivery: vaginal delivery (group A), cesarean section before the second stage of labor (group B), cesarean section during the second stage of labor (group C). The subsequent pregnancy was the first subsequent pregnancy, conducted after 16 weeks of gestation. The primary outcome was spontaneous preterm birth in the subsequent pregnancy, defined as delivery before 37 weeks of gestation. Secondary endpoints included preterm rupture of membranes in the subsequent pregnancy. Results: Between 2003 and 2018, 7776 women (84.7%) in group A, 1263 (13.8%) in group B and 143 (1.5%) in group C were included. The adjusted odds ratio of spontaneous preterm birth before 37 weeks of gestation after second stage cesarean section was 2.4 (group C vs group A + B, 95% confidence interval: 1.2–4.8), P = 0.01). The rate of preterm rupture of membranes was also significantly higher in group C (6% vs 2% in group A, P = 0.009, 6% vs 3% in group B, P= 0.05) with OR = 3.0 (group C vs group A + B, 95% CI: 1.55–6.16, P < 0.001). Conclusion: History of term second stage of labor cesarean section is an independent risk factor for spontaneous preterm birth and for preterm rupture of membrane in the subsequent pregnancy. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the rate of implementation after adding vaginal disinfection to the cesarean section protocol and its effect on post cesarean infections and hospital readmissions.Study Design: This is an intervention study where two groups were compared. Women the year before (n = 1384) and one year following (n = 1246) the addition of vaginal disinfection, with povidone-iodine 1% prior to the cesarean section, to the protocol. Primary outcome was the rate of implementation. Secondary outcomes were the rates of endometritis, wound infection and postoperative fever. With the effect expressed in the number of hospital readmissions.Results: The implementation rate was 85.6%. Intention-to-treat analysis showed endometritis rates of 2.0% versus 1.1% (p = 0.07). For women with preoperative ruptured membranes there was a significant decrease in endometritis, from 3.4% to 1.3% (p = 0.02). Per-protocol analysis showed endometritis rates of 2.0% to 1.0% (p = 0.05). Women with ruptured membranes, 3.4% versus 1.3% (p = 0.02), and women who were in the second stage of labor, 4.7% versus 0.0% (p = 0.01), had a significant decrease in endometritis. For wound infection and postoperative fever rates were similar. The decrease of infections had a significant effect on hospital readmissions, 27 versus 10 (p = 0.04).Conclusion: The implementation of this quality improvement measure shows to be adequate as the vast majority of women undergoing a cesarean received vaginal disinfection. Vaginal disinfection showed a declining trend of endometritis and postoperative fever and for women with broken membranes prior to cesarean section the decrease in endometritis was significant. These beneficial effects have led to a statistical and clinically relevant decrease in hospital readmissions and thus cost reduction. [ABSTRACT FROM AUTHOR]