Abstract
ObjectiveTo examine the association between station of the fetal head at complete cervical dilation and duration of second stage of labor, as well as prolonged second stage of labor, without and with the use of analgesia (EA).Study designWe conducted a population-based retrospective cohort study of 3311 women with a singleton pregnancy, gestational age ≥ 370 weeks, and cephalic presentation. Station of the fetal head at complete cervical dilation was categorized as at the pelvic floor, beneath the ischial spines, but above the pelvic floor, and at or above the ischial spines. In logistic regression analysis, we defined prolonged second stage of labor as > 2 h without and > 3 h with EA in nulliparous women, and > 1 h and > 2 h, respectively, in parous women.ResultsSurvival curves demonstrated longer durations of second stage of labor in nulliparous women and women with EA in each category of station of fetal head. The adjusted odds ratio of prolonged second stage of labor was 13.1 (95% confidence interval (CI): 8.5-20.1) times higher when the fetal head was beneath the ischial spines, but above the pelvic floor, and 32.9 (95% CI: 21.5-50.2) times higher when the fetal head was at or above the ischial spines compared to at the pelvic floor.ConclusionStation of the fetal head at complete cervical dilation was significantly associated with duration of second stage of labor.
Highlights
The second stage of labor encompasses the events between complete cervical dilation and delivery of the fetus
[10] These and other reports [12,13] led the ACOG/Society for Maternal- Fetal Medicine (SMFM) to publish new labor management guidelines [14], which accepted an additional hour of duration of the second stage of labor in both nulliparous and parous women before diagnosing arrest
Station of the fetal head at complete cervical dilation and the rate of fetal descent are not included in the new guidelines in regard to normal duration of second stage of labor or the definitions of prolonged second stage of labor
Summary
The second stage of labor encompasses the events between complete cervical dilation and delivery of the fetus. Station of the fetal head at complete cervical dilation and the rate of fetal descent are not included in the new guidelines in regard to normal duration of second stage of labor or the definitions of prolonged second stage of labor.
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