IMPACT OF OBSTETRIC PROLONGED SECOND STAGE OF LABOUR (PSSL) ≥3 HOURS DURATION ON NEONATAL OUTCOMES. 1133

Abstract

Background: Early studies of PSSL found an increased incidence of infant and maternal morbidity. More recent studies have contraindicated these earlier findings. Objective: As management of second stage of labour has shifted to a less “interventionist” strategy, a retrospective chart review was conducted to ensure that neonatal and maternal outcomes were not adversely affected by change in this policy. Prolonged second stage of labour (PSSL) was defined as a duration of three hours or more.Method: Retrospective chart review of all full term singleton cephalic presentation deliveries with PSSL from 1 Jan 1993 to 30 June 1994.Results: During the study period, 409(8.5%) of 4796 births were associated with PSSL: 33.5% were spontaneous vaginal births, 48.2% required forceps/vacuum extraction, 18.3% required Cesarean section. 58 of the 409 infants (14.2%) were admitted to NICU for the following reasons: Transient tachypnea (55%), meconium aspiration (10.3%), pneumothorax (12%), sepsis/suspected sepsis requiring antibiotic treatment (50%), asphyxia/hypoxic ischemic encephalopathy (10.3%). 19 infants had signs of birth trauma which included cephalhematoma, brachial plexus injury and facial nerve injury. There were 3 neonatal deaths (5.2%). Maternal morbidity included the following: Postpartum hemorrhage (16.8%), third degree perineal tear (36.2%), fourth degree perineal tear (13.8%). Conclusions: The incidence of neonatal morbidity was unexpectedly high as was maternal morbidity. These data suggest that all patients with PSSL require critical intrapartum assessment. A case controlled study is required to critically determine specific variables that are associated with adverse neonatal and maternal outcomes with PSSL.