Duration of second stage and maternal and neonatal outcomes in high risk gravidas populations after application of new partogram

Abstract

Objective To investigate the association between the duration of second stage of labor and maternal and neonatal outcomes in pregnant women complicated with hypertensive disorders, dysglycaemia (including gestational diabetes mellitus and diabetes mellitus complicating pregnancy) or primipara-in-advanced-age, and in normal pregnant women after implementation of new partogram. Methods A retrospective analysis was performed on all nulliparous women with the duration of second stage of labor≥ 2 h at Beijing Obstetrics and Gynecology Hospital, Capital Medical University between October 1, 2014 and March 31, 2015. Women with preterm labor, multiple gestation, noncephalic presentations, fetal malformations, placenta previa, or induction of labor after fetal death were excluded. And 279 women who met the inclusion criteria served as study group. Among the 279 women, 25 had hypertensive disorders (hypertension group), 46 had dysglycaemia (dysglycaemia group), and 35 had primipara-in-advanced-age (primipara-in-advanced-age group), and the remaining 177 women served as ordinary study group. According to the duration of second stage, the ordinary study group was divided into three subgroups: ≥2-<2.5 h (n=90), ≥2.5-<3 h (n=51) , and ≥3 h (n=36). And 340 women with the duration <2 h were selected randomly as control group, including 24 with hypertensive disorders (hypertension control group), 61 with dysglycaemia (dysglycaemia control group), and 41 with primipara-in-advanced-age (primipara-in-advanced-age control group); the remaining 226 women served as ordinary control group. Maternal and neonatal outcomes in these two groups were analyzed with Rank sum test, Chi-square test or Fisher's exact test. Results (1) Dysglycaemia group had a longer first stage of labor, lower rate of spontaneous labor and higher rate of forcep-assisted delivery than its counterpart control group [11.88(8.42-16.06) vs 8.17(5.00-14.12) h, 67.4%(31/46) vs 91.8%(56/61), and 30.4%(14/46) vs 8.2%(5/61), respectively, all P 3 h subgroup had a longer first stage of labor, higher labor intervention rate, and lower spontaneous labor rate (all P<0.05). Ordinary study group and ≥3 h subgroup had higher rates of labor analgesia and forcep-assisted delivery than the ordinary control group. The forcep-assisted delivery rate in ≥2.5-<3 h subgroup and cesarean section rate in ≥3 h subgroup were all higher than in ordinary control group (P<0.05). (2) Hypertension group had a higher incidence of postpartum hemorrhage than its corresponding control group while primipara-in-advanced-age group had a higher incidence [48.0%(12/25) vs 20.8%(5/24), and 34.3%(12/35) vs 7.3%(3/41), both P<0.05). Ordinary study group, ≥2.5-<3 h subgroup and ≥3 h subgroup had higher rates of postpartum hemorrhage and adverse wound healing than the ordinary control group (all P<0.05). (3) Compared with ordinary control group, ≥2-<2.5 h subgroup had a higher rate of neonatal asphyxia, ≥2.5-<3 h subgroup had higher fetal macrosomia proportion, and ≥3 h subgroup had a higher rate of admission to neonatal intensive care unit (all P<0.05). In ordinary study group, 6(3.4%) out of the 177 cases had neonatal asphyxia, all in the ≥2-<2.5 h subgroup [6.7%(6/90)], which was higher than in the ordinary control group [0.9% (2/226)], P<0.05. Conclusions With the prolonged duration of the second stage, the risk of adverse maternal and neonatal outcomes increases. For pregnant women complicated with hypertensive disorders, dysglycaemia or primipara-in-advanced-age, the duration of the second stage of should not be prolonged. Key words: Labor stage, second; Pregnancy outcome; Hypertension, pregnancy-induced; Glucose metabolism disorders; Parity