The impact of stage of labor on adverse maternal and neonatal outcomes in multiparous women: a retrospective cohort study

BMC Pregnancy and Childbirth

Jie Zhou¹  Wenjie Qing²  Fan Li³  Lu Jia⁴  Li Wang⁵  Hongxia Wang⁶ 

[1] Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, 02115, Boston, MA, USA;Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, 02115, Boston, MA, USA;Department of Obstetrics, Chengdu Women’s and Children’s Central Hospital, 610073, Chengdu, China;Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, 02115, Boston, MA, USA;Department of Otolaryngology-Head and Neck Surgery, Chongqing general hospital, University of Chinese Academy of Science, 40001, Chongqing, China;Department of Obstetrics and Gynecology, Hebei General Hospital, Hebei Medical University, 050051, Shijiazhuang, China;Department of Obstetrics and Gynecology, Hebei General Hospital, Hebei Medical University, 050051, Shijiazhuang, China;Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, 02115, Boston, MA, USA;Department of Obstetrics and Gynecology, Hebei General Hospital, North China University of Science and Technology, 050051, Shijiazhuang, China;

关键词: First stage of labor;    Second stage of labor;    Maternal outcomes;    Neonatal outcomes;    Adverse outcomes;    Multiparous women;   

DOI  :  10.1186/s12884-020-03286-z

来源: Springer

【 摘 要 】

BackgroundThe correlation between stage of labor and adverse delivery outcomes has been widely studied. Most of studies focused on nulliparous women, it was not very clear what impact the stage of labor duration had on multiparous women.MethodsA retrospective cohort study was conducted among all the multiparous women of cephalic, term, singleton births, who planned vaginal delivery. The total stage of labor covered the first stage and the second stage in this study, and they were divided into subgroups. Adverse maternal outcomes were defined as referral cesarean delivery, instrumental delivery, postpartum hemorrhage, perineal laceration (III and IV degree), hospitalization stay ≥90th, and adverse neonatal outcomes as NICU, shoulder dystocia, Apgar score ≤ 7(5 min), neonatal resuscitation, assisted ventilation required immediately after delivery.ResultsThere were 7109 parturients included in this study. The duration of first stage was 6.2(3.6–10.0) hours, the second stage was 0.3(0.2–0.7) hour, the total stage was 6.9(4.1–10.7) hours in multiparous women. At the first stage, the rates of overall adverse outcome were 21, 23.4, 28.8, 35.5, 38.4% in subgroups < 6 h, 6–11.9 h, 12–17.9 h, 18–23.9 h, ≥24 h, which increased significantly (X2 = 57.64, P < 0.001), and ARR (95% CI) were 1.10 (0.92,1.31), 1.33 (1.04,1.70), 1.80 (1.21,2.68), 2.57 (1.60,4.15) compared with subgroup < 6 h (ARR = 1); At the second stage, the rates of overall adverse outcome were 20.0, 30.7, 38.5, 61.2, 69.6% in subgroups < 1 h, 1–1.9 h, 2–2.9 h, 3–3.9 h, ≥4 h (X2 = 349.70, P < 0.001), and ARR (95% CI) were 1.89 (1.50, 2.39), 2.22 (1.55, 3.18), 10.64 (6.09, 18.59), 11.75 (6.55, 21.08) compared with subgroup < 1 h (ARR = 1)). At the total stage, the rates of overall adverse outcome were 21.5, 30.8, 42.4% in subgroups < 12 h, 12–23.9 h, ≥24 h (X2 = 84.90, P < 0.001), and ARR (95% CI) were 1.41 (1.16,1.72), 3.17 (2.10,4.80) compared with subgroup < 12 h (ARR = 1).ConclusionsThe prolonged stage of labor may lead to increased adverse outcomes in multiparous women, it was an independent risk factor of adverse maternal and neonatal outcomes.

【 授权许可】

CC BY