The following is a summary of “Passive second stage of labor: does a fourth hour increase maternal morbidity in nulliparous patients at term with epidural?,” published in the June 2024 issue of Obstetrics & Gynecology by Collinot et al.

This retrospective observational cohort study was conducted at a tertiary maternity unit from January 1 to December 31, 2020. It included consecutive-term nulliparous women who underwent delivery under epidural anesthesia without pathological fetal heart rate patterns and experienced a passive second stage of labor lasting at least 3 hours. Patients were divided into two groups based on the duration of the passive second stage: the “3-hour group” and the “4-hour group”. In the “3-hour group”, pushing was initiated within 3 hours if conditions were favorable; otherwise, cesarean section was considered. In the “4-hour group”, pushing was delayed beyond 3 hours under conditions where expectant management might facilitate successful vaginal delivery, as deemed appropriate by the obstetric team. The primary outcome assessed was a composite measure of maternal morbidity, including obstetric anal sphincter injuries, postpartum hemorrhage, transfusion, and intrauterine infection.

A total of 111 patients were included in the “4-hour group” and 349 in the “3-hour group”. There was no significant increase in composite maternal morbidity in the “4-hour group” compared to the “3-hour group” (18.9% vs. 17.5%; p = 0.73). Neonatal morbidity rates were similar between the two groups. In the “4-hour group”, 82% of patients achieved vaginal deliveries, with 55.9% spontaneous and 26.1% assisted deliveries.

For carefully selected patients, extending the passive second stage of labor to 4 hours post-full dilation may be beneficial, resulting in a higher rate of vaginal deliveries with a low incidence of maternal and neonatal complications.

Source: sciencedirect.com/science/article/abs/pii/S2468784724000965