Table 2.
Delivery mode and adverse outcomes by duration of the second stage
| < 1 hr; (n= 1901) | 1-< 2 hr (n= 1251) | 2- <3 hr (n= 614) | 3- < 4 hr (n= 217) | 4-< 5 hrs (n= 97) | ≥5 hrs (n= 46) | Unadjusted OR (95% CI) or P | Adjusted OR (95% CI) ˆ | |
|---|---|---|---|---|---|---|---|---|
| Delivery Mode | ||||||||
| Spontaneous | 1620 (85.2) | 984 (78.7) | 363 (59.1) | 59 (27.2) | 24 (24.7) | 4 (8.7) | <0.01 | -- |
| Operative Vaginal | 254 (13.4) | 226 (18.1) | 173 (28.2) | 75 (34.6) | 27 (27.8) | 10 (21.7) | ||
| Cesarean | 27 (1.4) | 41 (3.3) | 78 (12.7) | 83 (38.3) | 46 (47.4) | 32 (69.6) | ||
| Maternal outcomes | ||||||||
| Chorioamnionitis | 20 (1.1) | 49 (4.2) | 41 (7.1) | 29 (14.8) | 9 (10.6) | 3 (6.5) | 1.68 (1.51, 1.87) | 1.60 (1.40, 1.83) |
| 3rd or 4th degree perineal laceration | 96 (5.1) | 101 (8.4) | 74 (13.8) | 45 (33.6) | 12 (23.5) | 4 (28.6) | 1.80 (1.62, 1.99) | 1.44 (1.29, 1.60) |
| Endometritis | 51 (2.7) | 33 (2.6) | 15 (2.4) | 13 (6.0) | 2 (2.1) | 7 (15.2) | 1.25 (1.09, 1.43) | 1.07 (0.90, 1.26) |
| Uterine atony | 57 (3.0) | 45 (3.6) | 30 (4.9) | 17 (7.8) | 7 (7.2) | 4 (8.7) | 1.29 (1.15, 1.45) | 1.31 (1.14, 1.51) |
| Blood transfusion | 11 (0.6) | 12 (1.0) | 6 (1.0) | 4 (1.8) | 1 (1.0) | 2 (4.3) | 1.38 (1.11, 1.72) | 1.30 (0.99, 1.71) |
| Neonatal Outcomes | ||||||||
| 5-minute Apgar < 4 | 0 (0.0) | 2 (0.2) | 1 (0.2) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 1.34 (0.62, 2.88) | 1.05 (0.34, 2.46) |
| Umbilical artery pH < 7.0 | 4 (0.2) | 6 (0.6) | 4 (0.8) | 1 (0.5) | 1 (1.2) | 0 (0.0) | 1.30 (0.91, 1.87) | 0.98 (0.63, 1.53) |
| Intubation in delivery room | 7 (0.4) | 7 (0.6) | 5 (0.8) | 0 (0.0) | 1 (1.0) | 0 (0.0) | 1.14 (0.80, 1.62) | 0.99 (0.65, 1.51) |
| Neonatal intensive care | 61 (3.2) | 62 (5.0) | 29 (4.7) | 15 (6.9) | 9 (9.3) | 5 (10.9) | 1.27 (1.14, 1.42) | 1.13 (0.98, 1.29) |
| Sepsis | 2 (0.1) | 3 (0.2) | 1 (0.2) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 1.04 (0.52, 2.10) | 0.88 (0.38, 2.03) |
| Brachial plexus injury | 3 (0.2) | 2 (0.2) | 4 (0.7) | 1 (0.5) | 1 (1.0) | 0 (0.0) | 1.41 (0.96, 2.06) | 1.78 (1.08, 2.78) |
| Composite# | 33 (1.7) | 36 (2.9) | 19 (3.1) | 10 (4.6) | 4 (4.1) | 2 (4.4) | 1.25 (1.08, 1.45) | 1.09 (0.91, 1.30) |
Data are presented as number (percent)
ˆ
Odds ratio (95% confidence interval) for each additional hour of the second stage adjusted for mode of delivery
#
Any of the following: a 5-minute Apgar score below 4, an umbilical artery pH under 7.0, seizures, intubation in the delivery room, stillbirth, neonatal death, or admission to a neonatal intensive care unit for more than 48 hours