Prolonged passive second stage of labour in nulliparous women : A multi perspective study

Aim: This study aimed to describe the prolonged passive second stage of labour in nulliparous women in relation to its prevalence, risk factors, birth outcomes, midwives’ intrapartum management, and women's birth experiences.  Methods: Study I was a qualitative study in which 36 midwives participated in seven focus group discussions. Data were analysed using qualitative content analysis. Studies II and III were retrospective observational cohort studies where medical records from 1131 nulliparous women in Sweden were reviewed. Analyses were performed using descriptive statistics and multivariable logistic regression. Study IV included 15 individual interviews with nulliparous women who had a passive second stage lasting three hours or more. Data were analysed using thematic analysis based on descriptive phenomenology. Results: Midwives’ management of the passive phase is complex, especially if progress is slow. Guidelines were considered, but women were preferably managed individually. The prevalence of prolonged passive second stage (≥2h) was 38%. Epidural analgesia, malpresentation, maternal age ≥30 years, and birth weight of ≥4 kg were identified as risk factors for prolonged passive second stage. Longer duration of the passive second stage was associated with an increased risk of operative delivery. There were no associations with adverse maternal outcomes. Associations with adverse neonatal outcomes were found, although the rate of adverse neonatal outcomes were low in the study population. Women’s experiences of prolonged passive second stage were described in four themes: “An unknown phase”, “Trust and mistrust in the body’s ability”, ”Loss of control“, and “Support through presence and involvement”. Conclusion: This thesis describes the prolonged passive second stage from multiple perspectives, including midwives, epidemiological data, and women’s experiences. The midwives’ management of the passive second stage included a complex continuous process of assessment and balancing options for the next step. A prolonged passive second stage was common and did not result in increased risks of adverse maternal outcomes, although further fetal surveillance can be called for. Nulliparous women experienced the passive second stage as an unknown phase and expected a different path for birth, and the experience could include loss of control and increased need for emotional and physical support.

Prolonged passive second stage of labor in nulliparous women—Prevalence and risk factors : A historical cohort study

Introduction: This study examined the prevalence of and risk factors for a prolonged passive second stage of labor in nulliparous women. Material and Methods: This was a historical cohort study of all nulliparous women (n = 1131) at two delivery units in Sweden. Maternal and obstetric data were obtained from electronic medical records during 2019. Duration of the passive second stage was measured as time from retracted cervix to start of pushing. Prolonged passive second stage was defined as ≥2 h. Prevalence was calculated and associations between prolonged passive second stage and maternal, obstetric and neonatal characteristics and potential risk factors were assessed using logistic regression models. Results: The prevalence of prolonged passive second stage was 37.6%. Factors associated with an increased risk of prolonged passive second stage were epidural analgesia (adjusted odds ratio [aOR] 3.93; 95% confidence interval [CI] 2.90–5.34), malpresentation (aOR 2.26; 95% CI 1.27–4.05), maternal age ≥ 30 years (aOR 2.00; 95% CI 1.50–2.65) and birth weight ≥ 4 kg (aOR 1.50; 95% CI 1.05–2.15). Maternal body mass index ≥30 (aOR 0.52; 95% CI 0.34–0.79) and noncohabiting (aOR 0.51; 95% CI 0.30–0.89) reduced the odds of prolonged passive second stage. Conclusions: A prolonged passive second stage of labor in nulliparous women is common (n = 425 [38%]). We found epidural analgesia, malpresentation, maternal age ≥ 30 years and birthweight ≥4 kg to be major risk factors associated with an increased risk of a prolonged passive second stage. Birth outcomes for prolonged passive second stage need to be investigated to strengthen evidence for the management of the second stage of labor

Mode of delivery and birth outcomes in relation to the duration of the passive second stage of labour : A retrospective cohort study of nulliparous women

OBJECTIVE: To investigate the mode of delivery and birth outcomes in relation to the duration of the passive second stage of labour in nulliparous women. METHODS AND FINDINGS: A retrospective cohort study of all nulliparous women (n = 1131) at two delivery units in Sweden. Maternal and obstetric data were obtained from electronic medical records during 2019. The passive second stage was defined as the complete dilation of the cervix until the start of the active second stage. The duration of the passive second stage was categorized into three groups: 0 to 119 min (0 to 2h) of the passive second stage in nulliparous women, although most of the women gave birth by spontaneous vaginal delivery even after ≥4 hours. There was no evidence of an increased risk of adverse maternal outcomes in a longer duration of the passive second stage but there were indications of increased adverse neonatal outcomes. Assessment of fetal well-being is important when the duration of the passive phase is prolonged

Histogram of negative birth experience in relation to mode of delivery.

Histogram of negative birth experience in relation to mode of delivery.</p

Maternal and neonatal outcomes in relation to the duration of the passive second stage: Crude odds ratio and multivariable adjusted logistic regression models with 95% CI.

Maternal and neonatal outcomes in relation to the duration of the passive second stage: Crude odds ratio and multivariable adjusted logistic regression models with 95% CI.</p

Histogram of intra or post-partum infection in relation to mode of delivery.

Histogram of intra or post-partum infection in relation to mode of delivery.</p

Flow chart of the study population.

Flow chart of the study population.</p

Maternal, obstetric and neonatal characteristics of the study population at baseline, presented as mean (SD) or n (%).

Maternal, obstetric and neonatal characteristics of the study population at baseline, presented as mean (SD) or n (%).</p

Mode of delivery in relation to the duration of the passive second stage.

Mode of delivery in relation to the duration of the passive second stage.</p

STROBE statement—checklist of items that should be included in reports of <i>cohort studies</i>.

(PDF)</p