448 Combination of early pushing with extended second stage might increase adverse maternal and neonatal outcomes

Abstract

To evaluate the effect of combining the technique of early pushing and extended second stage on the rate of cesarean deliveries, as well as adverse maternal and neonatal outcomes. This retrospective data analysis included all women delivering in a single tertiary medical center through 2015-2020. In January 2017 the protocol of second stage management was changed to a combination of extended second stage (i.e. addition of an extra-hour to the traditional Fridman cutoffs), as well as early pushing (i.e. initiation of active pushing within the first 30 minutes of full dilatation). We compared delivery outcomes in women reaching full dilatation during January 2015 to December 2016, vs. January 2017 to July 2020. Of the 15,788 parturients, 10,415 (66.0%) were managed using the "new" protocol. No difference was found in terms of baseline characteristics, except for higher rates of epidural analgesia (72.8% vs. 70.4%, p=0.002) and induction of labor (22.4% vs. 17.8%, p<0.0001) during the new protocol period. In subgroup analysis by parity and epidural analgesia, no change was noted in the rate of cesarean deliveries. A significant increase in spontaneous vaginal deliveries in favor of the "new" protocol was noted, except for multiparous women with no analgesia (Table 1). In addition, in primiparous women with epidural analgesia, a decrease in vacuum deliveries was noted. In secondary outcome analysis, a significant increase in postpartum hemorrhage was noted in women with epidural analgesia, both primi- and multiparous (Table 2). In addition, marked increase was demonstrated in neonatal intensive care unit admissions (up to OR 15.48 (95%CI 3.78-63.42) in primiparous women with epidural analgesia), in all subgroups except for primipara without epidural. Early pushing along with extension of the second stage was associated with higher rate of spontaneous vaginal deliveries, at the expense of increased risk for adverse maternal and neonatal outcomes. Thus, combination of these two techniques must be practiced with caution.View Large Image Figure ViewerDownload Hi-res image Download (PPT)