Research article summary (published 29 Sep 2009):

When to stop pushing: effects of duration of second-stage expulsion efforts on maternal and neonatal outcomes in nulliparous women with epidural analgesia.

Full Abstract

OBJECTIVE: The purpose of this study was to assess the influence of the duration of active second-stage labor on maternal and neonatal outcomes. STUDY DESIGN: Secondary analysis of the Pushing Early Or Pushing Late with Epidural trial that included 1862 nulliparous women with epidural analgesia who were in the second stage of labor. According to duration of active second-stage labor, we estimated the proportion of spontaneous vaginal deliveries (SVD) with a newborn infant without signs of asphyxia (5-minute Apgar score > or =7 and arterial pH >7.10). We also analyzed maternal and neonatal outcomes according to the duration of expulsive efforts. RESULTS: Relative to the first hour of expulsive efforts, the chances of a SVD of a newborn infant without signs of asphyxia decreased significantly every hour (1- to 2-hour adjusted odds ratio, 0.4; 95% confidence interval [CI], 0.3-0.6; 2- to 3-hour adjusted odds ratio, 0.1; 95% CI, 0.09-0.2; >3-hour adjusted odds ratio, 0.03; 95% CI, 0.02-0.05). The risk of postpartum hemorrhage and intrapartum fever increased significantly after 2 hours of pushing. CONCLUSION: Faced with a decreasing probability of SVD and increased maternal risk of morbidity after 2 hours, we raise the question as to whether expulsive efforts should be continued after this time.

Author information

Author/s: Le Ray, Camille (C); Audibert, François (F); Goffinet, François (F); Fraser, William (W);

Affiliation: Department of Obstetrics and Gynecology, Sainte Justine Hospital, University of Montréal, Montreal, QC, Canada. camille.leray(-atsign-)gmail.com

Journal and publication information

Publication Type: Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't

Journal: American journal of obstetrics and gynecology (Am J Obstet Gynecol), published in United States. (Language: eng)

Reference: 2009-Oct; vol 201 (issue 4) : pp 361.e1-7

Dates: Created 2009/09/30; Completed 2009/10/22;

PMID: 19788968, status: MEDLINE (last retrieval date: 10/22/2009, IMS Date: )

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

Comments and Corrections

CommentIn: Am J Obstet Gynecol. 2009 Oct;201(4):337-8. (PMID: 19788964)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Adult Analgesia, Epidural Analgesia, Obstetrical Delivery, Obstetric Female Fever - epidemiology Humans Labor Stage, Second

Multivariate Analysis Parity Postpartum Hemorrhage - epidemiology Pregnancy Pregnancy Outcome Risk Factors Time Factors Young Adult

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