Table 3.
Maternal and Neonatal Outcomes According to Duration of Second Stage in Nulliparous Women by Epidural Status
| Nulliparous With Epidural | Nulliparous Without Epidural | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Within Guidelines 0 to ≤ 3 hours n (%) |
Prolonged Second Stage > 3 hours n (%) |
P | Unadjusted OR (95% CI) |
Adjusted OR (95% CI) |
Within Guidelines 0 to ≤ 2 hours n (%) |
Prolonged Second Stage > 2 hours n (%) |
P | Unadjusted OR (95% CI) |
Adjusted OR (95% CI) |
|
| n | 32124 (90.1) | 3533 (9.9) | 7023 (86.1) | 1130 (13.9) | ||||||
| Maternal outcomes | ||||||||||
| Endometritis | 120 (0.4) | 42 (1.2) | <.001 | 3.21 (2.25, 4.57) | 3.52 (2.44, 5.06) | 26 (0.8) | 9 (0.7) | 0.047 | 2.16 (1.01, 4.62) | - |
| Postpartum hemorrhage | 1203 (3.7) | 207 (5.9) | <.001 | 1.60 (1.37, 1.86) | 1.50 (1.27, 1.78) | 271 (3.9) | 58 (5.1) | 0.044 | 1.35 (1.01, 1.80) | 1.25 (0.87, 1.80) |
| Cesarean hysterectomy | 7 (0.02) | 1 (0.03) | 0.807 | 1.30 (0.16, 10.56) | - | 1 (0.01) | 1 (0.1) | 0.196 | 6.22 (0.39, 99.51) | 5.36 (0.30, 96.14) |
| ICU admission | 114 (0.5) | 5 (0.2) | 0.048 | 0.40 (0.17, 0.99) | 0.49 (0.20, 1.21) | 10 (0.2) | 1 (0.1) | 0.750 | 0.72 (0.09, 5.60) | 1.55 (0.18, 13.57) |
| Transfusion | 1003 (4.7) | 99 (4.4) | 0.508 | 0.93 (0.75, 1.15) | 1.03 (0.83, 1.29) | 77 (2.2) | 8 (1.4) | 0.232 | 0.64 (0.31, 1.33) | 0.82 (0.38, 1.75) |
| Chorioamnionitis | 1285 (4.0) | 392 (11.1) | <.001 | 3.00 (2.66, 3.37) | 3.01 (2.65, 3.43) | 128 (1.8) | 63 (5.6) | <.001 | 3.18 (2.34, 4.33) | 3.82 (2.69, 5.42) |
| Wound infection | 48 (0.2) | 5 (0.2) | 0.859 | 1.09 (0.43, 2.73) | 1.12 (0.45, 2.79) | 5 (0.1) | 1 (0.2) | 0.694 | 1.54 (0.18, 13.20) | 1.77 (0.19,16.25) |
| Wound separation | 5 (0.02) | 5 (0.2) | <.001 | 10.43 (3.02, 36.05) | 12.13 (3.63, 40.46) | 1 (0.02) | 0 (0) | |||
| Episiotomy (%) | 12313 (38.3) | 1193 (33.8) | <.001 | 0.82 (0.76, 0.88) | 0.83 (0.76, 0.90) | 2171 (30.9) | 459 (40.6) | <.001 | 1.53 (1.34, 1.74) | 1.43 (1.20, 1.70) |
| 3rd/4th degree perineal laceration | 1863 (5.8) | 358 (10.1) | <.001 | 1.83 (1.63, 2.06) | 1.80 (1.58, 2.05) | 409 (5.8) | 112 (9.9) | <.001 | 1.78 (1.43, 2.22) | 1.62 (1.24, 2.12) |
| Cervical laceration | 265 (0.8) | 20 (0.6) | 0.103 | 0.68 (0.43, 1.08) | 0.77 (0.49, 1.23) | 61 (0.9) | 2 (0.2) | 0.026 | 0.20 (0.05, 0.83) | - |
| Hospital length of stay – Median (10th, 90th percentiles) | 2 (2, 3) | 3 (2, 4) | <.001 | 2 (1, 3) | 3 (2, 4) | <.001 | ||||
| Neonatal outcomes | ||||||||||
| Shoulder dystocia | 449 (1.5) | 63 (1.9) | 0.056 | 1.30 (0.99, 1.69) | 1.33 (0.99, 1.78) | 82 (1.2) | 16 (1.5) | 0.500 | 1.20 (0.70, 2.07) | 1.68 (0.91, 3.09) |
| 5-minute Apgar <4 | 66 (0.2) | 18 (0.5) | <.001 | 2.49 (1.48, 4.19) | 2.71 (1.49, 4.93) | 30 (0.4) | 4 (0.4) | 0.724 | 0.83 (0.29, 2.35) | 0.91 (0.27, 3.09) |
| Need for CPAP or greater | 322 (1.0) | 44 (1.2) | 0.175 | 1.25 (0.91, 1.71) | 1.27 (0.90, 1.79) | 32 (0.5) | 7 (0.6) | 0.461 | 1.36 (0.60, 3.09) | 1.20 (0.43, 3.35) |
| NICU admission | 1892 (5.9) | 288 (8.2) | <.001 | 1.42 (1.25, 1.61) | 1.39 (1.20, 1.60) | 356 (5.1) | 97 (8.6) | <.001 | 1.76 (1.39, 2.22) | 1.85 (1.38, 2.49) |
| Sepsis | 395 (1.2) | 92 (2.6) | <.001 | 2.15 (1.71, 2.70) | 2.08 (1.60, 2.70) | 76 (1.1) | 20 (1.8) | 0.049 | 1.65 (1.00, 2.71) | 2.34 (1.28, 4.27) |
| Pneumonia | 231 (0.7) | 24 (0.7) | 0.790 | 0.94 (0.62, 1.44) | 1.05 (0.68, 1.63) | 29 (0.4) | 10 (0.9) | 0.037 | 2.15 (1.05, 4.43) | 2.15 (0.83, 5.54) |
| HIE/PVL | 5 (0.02) | 0 (0) | 1 (0.01) | 1 (0.1) | 0.196 | 6.22 (0.39, 99.51) | - | |||
| Seizure | 35 (0.1) | 4 (0.1) | 0.942 | 1.04 (0.37, 2.93) | 0.85 (0.25, 2.95) | 2 (0.03) | 2 (0.2) | 0.068 | 6.22 (0.88, 44.23) | - |
| ICH/PVH | 50 (0.2) | 6 (0.2) | 0.840 | 1.09 (0.47, 2.55) | 0.67 (0.21, 2.16) | 4 (0.1) | 3 (0.3) | 0.044 | 4.67 (1.04, 20.90) | - |
| Asphyxia | 47 (0.1) | 11 (0.3) | 0.024 | 2.13 (1.10, 4.11) | 2.39 (1.22, 4.66) | 8 (0.1) | 4 (0.4) | 0.064 | 3.12 (0.94, 10.36) | 3.83 (1.00, 14.72) |
| Perinatal mortality | 10 (0.03) | 0 (0) | 3 (0.04) | 2 (0.18) | 0.119 | 4.15 (0.69, 24.86) | 5.92 (1.43, 24.51) | |||
| NICU length of stay – Median (10th, 90th percentiles) | 3.3 (1, 9) | 3.0 (1, 9) | 0.679 | 3 (1, 8) | 2 (1, 7) | 0.951 | ||||
| Cesarean delivery indication | ||||||||||
| Dystocia or cephalopelvic disproportion | 406 (60.5) | 616 (86.9) | <.001 | 4.32 (3.31, 5.65) | 4.53 (3.35, 6.13) | 19 (43.2) | 119 (81.0) | <.001 | 5.59 (2.71, 11.54) | 7.12 (2.36, 21.54) |
| Non-reassuring fetal heart rate tracing | 237 (35.3) | 51 (7.2) | <.001 | 0.14 (0.10, 0.20) | 0.13 (0.09, 0.19) | 27 (61.4) | 20 (13.6) | <.001 | 0.10 (0.05, 0.21) | 0.09 (0.02, 0.36) |
OR, odds ratio; CI, confidence interval; ICU, intensive care unit; CPAP, continuous positive airway pressure; HIE/PVL, hypoxic-ischemic encephalopathy/periventricular leukomalacia; ICH/PVH, intracranial hemorrhage/periventricular hemorrhage.
Maternal and neonatal composite outcomes include variables listed below.
Postpartum hemorrhage defined as estimated blood loss > 500 ml for vaginal delivery and >1000 ml for CD.
Analyses adjusted for maternal race/ethnicity, BMI, insurance, and region. Some analyses had too few numbers to calculate adjusted odds ratios.