Maternal and perinatal outcomes among laboring mothers with prolonged second stage of labor in four teaching hospitals Addis Ababa, Ethiopia
Abstract
Background: National and international organizations vary in their recommendations of what is an acceptable duration for the second stage of labor, with ongoing international debate and some groups defending a longer duration. In this millennium, instead, in the absence of maternal or fetal complications, consensus among providers seems to be shifting toward relaxing the definition of the second stage of labor.
Objective: To assess neonatal and maternal outcomes when the second stage of labor is prolonged beyond the national guideline.
Study design: A facility-based cross sectional descriptive study was undertaken on laboring mothers who went into prolonged second stage.
Methods: Objective structured questioners were used to collect full data from 406 women. Operative delivery, uterine atony, genital tract injury, and infectious morbidities from the maternal side, as well as neonatal admission, low Apgar score were assessed. The association between variables was done using chi square,for categories and for predictors with logistic regression analysis.
Result: 7.8% (406) of the 5584 women on the second stage have prolonged second, 78.9% of them have achieved vaginal delivery. Most deliveries occurred within four hours. Only 46 of them stayed undelivered after 4hrs. Low apgar score and composite perinatal morbidities increased progressively with duration beyond 3 hrs p ( 0.05). Using multivariate logistic regression, labor duration beyond 4 hrs, instrumental delivery, and ROM > 18hrs have shown statistically significant associations for composite neonatal morbidity(p values of 0.000 and 0.002, ORadjusted.09 and 6.2 respectively).