Table 4.
Maternal and Neonatal Outcomes According to Duration of Second Stage in Multiparous Women by Epidural Status
| Multiparous With Epidural | Multiparous Without Epidural | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Within Guidelines 0 to ≤ 2 hours n (%) |
Prolonged Second Stage > 2 hours n (%) |
P | Unadjusted OR (95% CI) |
Adjusted OR (95% CI) |
Within Guidelines 0 to ≤ 1 hours n (%) |
Prolonged Second Stage > 1 hours n (%) |
P | Unadjusted OR (95% CI) |
Adjusted OR (95% CI) |
|
| n | 42088 (96.9) | 1348 (3.1) | 15219 (94.1) | 950 (5.9) | ||||||
| Maternal outcomes | ||||||||||
| Endometritis | 55 (0.1) | 3 (0.1) | 0.369 | 1.70 (0.53, 5.46) | 1.74 (0.53, 5.64) | 14 (0.1) | 0 (0) | |||
| Postpartum hemorrhage | 985 (2.3) | 45 (3.3) | 0.018 | 1.44 (1.07, 1.96) | 1.50 (1.07, 2.10) | 423 (2.8) | 36 (3.8) | 0.070 | 1.38 (0.97, 1.95) | 1.78 (1.18, 2.69) |
| Cesarean hysterectomy | 10 (0.02) | 1 (0.1) | 0.278 | 3.12 (0.40, 24.42) | - | 3 (0.02) | 0 (0) | |||
| ICU admission | 113 (0.3) | 4 (0.4) | 0.603 | 1.30 (0.48, 3.54) | 0.75 (0.28, 2.02) | 36 (0.3) | 1 (0.2) | 0.537 | 0.53 (0.07, 3.91) | 0.52 (0.07, 4.03) |
| Transfusion | 1687 (5.7) | 28 (4.2) | 0.092 | 0.74 (0.52, 1.05) | - | 227 (3.2) | 4 (1.0) | 0.184 | 0.48 (0.16, 1.42) | 0.76 (0.23, 2.45) |
| Chorioamnionitis | 315 (0.7) | 52 (3.9) | <.001 | 5.31 (3.94, 7.16) | 4.78 (3.46, 6.61) | 62 (0.4) | 9 (0.9) | 0.018 | 2.34 (1.16, 4.72) | - |
| Wound infection | 32 (0.1) | 1 (0.1) | 0.771 | 1.35 (0.18, 9.86) | 1.09 (0.13, 9.24) | 10 (0.1) | 0 (0) | |||
| Wound separation | 6 (0.02) | 0 (0) | 1 (0.01) | 0 (0) | ||||||
| Episiotomy (%) | 7431 (17.7) | 259 (19.2) | 0.159 | 1.10 (0.96, 1.27) | 1.44 (1.21, 1.70) | 1591 (10.5) | 183 (19.3) | <.001 | 2.03 (1.72, 2.41) | 1.86 (1.46, 2.36) |
| 3rd/4th degree perineal laceration | 325 (0.8) | 40 (3.0) | <.001 | 3.92 (2.82, 5.47) | 3.85 (2.65, 5.60) | 108 (0.7) | 18 (1.9) | 0.001 | 2.70 (1.63, 4.47) | 3.20 (1.71, 5.99) |
| Cervical laceration | 165 (0.4) | 5 (0.4) | 0.903 | 0.95 (0.39, 2.31) | 0.75 (0.27, 2.02) | 69 (0.5) | 2 (0.2) | 0.284 | 0.46 (0.11, 1.89) | 0.25 (0.03, 1.77) |
| Hospital length of stay – Median (10th, 90th percentiles) | 2 (1, 3) | 2 (2, 4) | <.001 | 2 (1, 3) | 2 (1, 3) | <.001 | ||||
| Neonatal outcomes | ||||||||||
| Shoulder dystocia | 761 (1.9) | 28 (2.2) | 0.410 | 1.17 (0.80, 1.72) | 1.04 (0.66, 1.62) | 246 (1.7) | 20 (2.2) | 0.294 | 1.28 (0.81, 2.03) | 1.78 (1.02, 3.09) |
| 5 minute Apgar <4 | 72 (0.2) | 6 (0.4) | 0.024 | 2.61 (1.13, 6.01) | 2.52 (1.01, 6.30) | 43 (0.3) | 7 (0.7) | 0.019 | 2.62 (1.18, 5.84) | 2.46 (0.93, 6.47) |
| Need for CPAP or greater | 253 (0.6) | 11 (0.8) | 0.320 | 1.36 (0.74, 2.49) | 1.30 (0.68, 2.48) | 61 (0.4) | 6 (0.6) | 0.287 | 1.58 (0.68, 3.66) | 2.53 (1.06, 6.05) |
| NICU admission | 1736 (4.1) | 84 (6.2) | <.001 | 1.55 (1.23, 1.94) | 1.57 (1.22, 2.03) | 606 (4.0) | 55 (5.8) | 0.007 | 1.48 (1.11, 1.97) | 1.35 (0.93, 1.96) |
| Sepsis | 271 (0.6) | 16 (1.2) | 0.018 | 1.85 (1.11, 3.07) | 1.73 (0.99, 3.05) | 109 (0.7) | 11 (1.2) | 0.128 | 1.62 (0.87, 3.03) | 1.84 (0.89, 3.82) |
| Pneumonia | 191 (0.5) | 7 (0.5) | 0.725 | 1.15 (0.54, 2.44) | 1.27 (0.55, 2.92) | 46 (0.3) | 5 (0.5) | 0.238 | 1.75 (0.69, 4.40) | 1.66 (0.51, 5.41) |
| HIE/PVL | 1 (0) | 0 (0) | 0 (0) | 0 (0) | ||||||
| Seizure | 16 (0.04) | 1 (0.1) | 0.517 | 1.95 (0.26, 14.73) | 2.07 (0.24, 17.82) | 7 (0.05) | 1 (0.1) | 0.439 | 2.29 (0.28, 18.63) | - |
| ICH/PVH | 32 (0.1) | 2 (0.1) | 0.359 | 1.95 (0.47, 8.16) | - | 4 (0.03) | 0 (0) | |||
| Asphyxia | 39 (0.1) | 2 (0.1) | 0.516 | 1.60 (0.39, 6.64) | 2.34 (0.56, 9.85) | 10 (0.1) | 1 (0.1) | 0.653 | 1.60 (0.20, 12.53) | - |
| Perinatal mortality | 12 (0.03) | 0 (0) | 5 (0.03) | 2 (0.21) | 0.025 | 6.45 (1.26, 33.07) | 6.34 (1.32, 30.34) | |||
| NICU length of stay – Median (10th, 90th percentiles) | 3.8 (1, 11) | 2.5 (1,8) | <.001 | 3 (1, 11) | 2 (1, 15) | 0.831 | ||||
| Cesarean delivery indication | ||||||||||
| Dystocia or cephalopelvic disproportion | 54 (44.6) | 118 (77.6) | <.001 | 4.31 (2.55, 7.27) | 4.76 (2.54, 8.95) | 3 (17.6) | 24 (66.7) | 0.002 | 9.33 (2.24, 38.87) | 23.88 (1.55, 366.83) |
| Nonreassuring fetal heart rate tracing | 53 (43.8) | 21 (13.8) | <.001 | 0.21 (0.11, 0.37) | 0.15 (0.08, 0.31) | 11 (64.7) | 10 (27.8) | 0.013 | 0.21 (0.06, 0.72) | 0.04 (0.00, 0.38) |
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; NICU, neonatal intensive care unit.
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 cesarean delivery.
Analyses adjusted for maternal race/ethnicity, BMI, insurance and region. Some analyses had too few numbers to calculate adjusted odds ratios.