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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 32  |  Issue : 2  |  Page : 128-134

Factors prolonging the duration of the second stage of labor


Department of Obstetrics and Gynecology, Pyongyang Medical College, Kim Il Sung University, Pyongyang, Democratic People's Republic of Korea

Date of Web Publication25-Oct-2018

Correspondence Address:
Dr. Yong-Chol Hong
Department of Obstetrics and Gynecology, Pyongyang Medical College, Kim Il Sung University, Ryonhwa-Dong, Central District, Pyongyang
Democratic People's Republic of Korea
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jms.jms_36_18

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  Abstract 

Aim: We have done this study to find factors prolonging the duration of the second stage of labor.
Background: The second stage of labor is a very important period in the clinical process of labor as dangers may occur suddenly to the fetus and parturient. Prolonged duration of the second stage of labor is related to somatic characters, pregnancy, and delivery history in addition to the three important elements of labor such as bearing down, birth canal, and fetus.
Objects: A total of 253 parturients between March 2012 and March 2015 were included in the study. Those parturients were divided into two groups: the first group was composed of 135 parturients with normal duration of the second stage of labor and the second group was composed of 118 parturients with prolonged duration of the second stage of labor.
Methods: Odds ratio test and 95% confidence interval were applied for the analysis between normal and prolonged group with somatic and obstetrical examination findings and laboratory and ultrasonography findings.
Results: The factors prolonging the duration of the second stage of labor contain height (<155 cm), body mass index (>28), body weight gaining during pregnancy (>8.0 kg), fetal position in the first stage of labor right occiput transverse (ROT) and fetal membrane condition (ruptured) for all of primipara and multipara, front wall length of uterus (>34 cm), perineum height (>3.6 cm), elapsed period of the first stage of labor (nighttime), Hb (<100 g/L), newborn's body weight (>3.0 kg) for primipa, age (over 30 years old), interval between the present and last delivery (>25 months), and the previous cesarean section for multipara.

Keywords: Duration of the second stage of labor, labor, parturient, prolonged factors


How to cite this article:
Hong YC, Paek US. Factors prolonging the duration of the second stage of labor. J Med Soc 2018;32:128-34

How to cite this URL:
Hong YC, Paek US. Factors prolonging the duration of the second stage of labor. J Med Soc [serial online] 2018 [cited 2018 Dec 15];32:128-34. Available from: http://www.jmedsoc.org/text.asp?2018/32/2/128/244131


  Introduction Top


The second stage of labor is the period when dangers may occur suddenly for the fetus and parturient, so this is a very important period for the clinical course of labor. The obstetricians have to find factors prolonging the second stage of labor and manage possible factors timely. Moreover, they have to give more careful midwifery to parturients with management impossible factors such as age, body weight, and height, the interval between the present and last delivery so that they can reduce the abnormal delivery rate and maintain the health of puerpera and newborn on a higher level.


  Methods Top


Objects

A total of 253 parturients who were hospitalized into the Pyongyang Maternity Hospital between March 2012 and March 2015 were included in the study. Two hundred and fifty-three parturients were divided into two groups: the first group was composed of 135 parturients with normal duration of the second stage of labor and the second group was composed of 118 parturients with prolonged duration of the second stage of labor. Parturients who were impossible to give delivery through the birth canal because of the special abnormalities of three important elements of labor such as bearing down, birth canal and fetus, and parturients with internal diseases and other obstetrical complications were excluded from the objects.

Composition of groups by age

As shown in [Table 1], in normal and prolonged group of 25–29 years, subgroups were composed of 52.6% and 55.1%, respectively, and there were no significant differences between two groups.
Table 1: Composition of groups by age

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Composition of groups by pregnancy weeks

As shown in [Table 2], in normal and prolonged group of 40–41 pregnancy weeks, subgroups were composed of 50.4% and 47.4%, respectively, and there were no significant differences between two groups.
Table 2: Composition of groups by pregnancy weeks

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Composition of groups by delivery times

As shown in [Table 3], in the normal and prolonged group, primipara subgroups were composed of 74.1% and 73.7%, respectively, and there were no significant differences between the two groups.
Table 3: Composition of groups by delivery times

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Methods

Group division of the duration of the second stage of labor and factors affecting it was based on the previous and basic research and the methods were as follows:

  • Duration of the second stage of labor means the time from complete opening of the cervical canal of the uterus to delivery of the fetus. Groups by duration of the second stage of labor were divided into 89 min >group (normal group) and 90 min n group (prolonged group) for primipara and 34 min >group (normal group) and 35 min ≤group (prolonged group) for multipara
  • The age of parturients was counted in full age. Groups by parturient's age were divided into 29 years >group and 30 years ≤group
  • The height of parturients was measured using tape measures. Groups by parturient's height were divided into 155 cm >group and 156 cm ≤group
  • Body mass index (BMI) was obtained by dividing body weight by a square of body height. Groups by parturient's BMI were divided into 27.9 >group and 28.0 ≤group
  • Groups by parturient's body weight gaining during pregnancy were divided into 7.9 kg >group and 8.0 ≤group
  • Groups by the interval between the present and last delivery (except abortion) were divided into 24 months >group and 25 months ≤group
  • Cesarean section history was confirmed by consultation and postoperative scars. Groups by cesarean section history were divided into positive group and negative group
  • Groups by fetal position in the uterus in the first stage of labor were divided into LOT group and ROT group
  • Front wall length of the uterus means curvilinear length between the superior border of the pubic symphysis and the top of the fundus of the uterus, and it was measured in centimeters using tape measures. Groups by front wall length of the uterus were divided into 33 cm >group and 34 cm ≤group
  • Perineum height means the length between the posterior labial commissure and anus, and it was measured using pelvimeter and centimeter ruler. Groups by parturient's perineum height were divided into 3.5 cm >group and 3.6 cm ≤group
  • Groups by the fetal membranes condition in the first stage of labor were divided into completed group (normal) and ruptured group (abnormal)
  • The elapsed time of the first stage of labor was determined using consultation and time elapse of partogram. Groups by elapsed period of the first stage of labor were divided into daytime group (over 50% of the elapsed period of the first stage was between 7 o'clock and 22 o'clock) and nighttime group (over 50% of elapsed period of the first stage was between 22 o'clock and 7 o'clock the next day)
  • Groups by parturients hemoglobin content was divided into 99 g/L >group and 100 g/L ≤group
  • The newborn's body weight was obtained by comparing body weight from ultrasound “ALOKA-SSD-256” and that from balance for measuring newborn's body weight. Groups by newborn's body weight were divided into 2.9 kg >group and 3.0 kg ≤group.


Analysis of the factors of prolonged duration of the second stage of labor was as follows:

Odds ratio test (OR-test) and 95% confidence interval (95% CI) were applied for analysis between normal group and prolonged group. If OR value is >1 and the value <95% CI is >1, the factor was regarded as prolonging the duration of the second stage of labor. If OR value is <1 and the value >95% CI is <1, the factor was also regarded as prolonging the duration of the second stage of labor.


  Results Top


Relationship between parturient's somatic findings and duration of the second stage of labor

Relationship between parturient's age and duration of the second stage of labor

As shown in [Table 4], OR of duration of the second stage of labor according to parturient's age in primipara was 1.85 (95% CI: 0.98–3.51), and age is not the significant factor that may prolong the duration of the second stage of labor; but OR of duration of the second stage of labor according to parturient's age in multipara was 3.08 (95% CI: 1.13–8.41), and age is the significant factor that may prolong the duration of the second stage of labor.
Table 4: Relationship between parturients age and duration of the second stage of labor

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Relationship between parturient's height and duration of the second stage of labor

As shown in [Table 5], OR of duration of the second stage of labor according to parturient's height in all of primipara and multipara was 0.52 (95% CI: 0.29–0.93) and 0.32 (95% CI: 0.12–0.87), respectively, and height is the significant factor that may prolong the duration of the second stage of labor.
Table 5: Relationship between parturients height and duration of the second stage of labor

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Relationship between parturient's BMI and duration of the second stage of labor

As shown in [Table 6], OR of duration of the second stage of labor according to parturient's BMI in all of primipara and multipara was 2.48 (95% CI: 1.28–4.81) and 4.94 (95% CI: 1.52–16.1), respectively, and BMI is the significant factor that may prolong the duration of the second stage of labor.
Table 6: Relationship between parturients body mass index and duration of the second stage of labor

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Relationship between parturient's body weight gaining during pregnancy and duration of the second stage of labor

As shown in [Table 7], OR of duration of the second stage of labor according to body weight gaining during pregnancy in all of primipara and multipara was 2.28 (95% CI: 1.16–4.48) and 3.60 (95% CI: 1.25–10.37), respectively, and body weight gaining during pregnancy is the significant factor that may prolong the duration of the second stage of labor.
Table 7: Relationship between parturients body weight gaining during pregnancy and duration of the second stage of labor

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Relationship between parturient's obstetrical examination findings and duration of the second stage of labor

Relationship between interval between the present and last delivery and duration of the second stage of labor

As shown in [Table 8], OR of duration of the second stage of labor according to the interval between present and last delivery in multipara was 3.08 (95% CI: 1.13–8.41), and interval between present and last delivery is the significant factor that may prolong the duration of the second stage of labor.
Table 8: Relationship between interval between present and last delivery and duration of the second stage of labor

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Relationship between cesarean section history and duration of the second stage of labor

As shown in [Table 9], OR of duration of the second stage of labor according to cesarean section history in multipara was 3.08 (95% CI: 1.09–8.67), and cesarean section history is the significant factor that may prolong the duration of the second stage of labor.
Table 9: Relationship between cesarean section history and duration of the second stage of labor

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Relationship between fetal position in uterus and duration of the second stage of labor

As shown in [Table 10], OR of duration of the second stage of labor according to fetal position in uterus in all of primipara and multipara was 2.23 (95% CI: 1.23–4.03) and 3.97 (95% CI: 1.42–11.06), respectively, and fetal position in the uterus is the significant factor that may prolong the duration of the second stage of labor.
Table 10: Relationship between fetal position in uterus and duration of the second stage of labor

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Relationship between front wall length of the uterus and duration of the second stage of labor

As shown in [Table 11], OR of duration of the second stage of labor according to front wall length of uterus in primipara was 2.02 (95% CI: 1.03–3.96), and front wall length of uterus is the significant factor that may prolong the duration of the second stage of labor; but OR of duration of the second stage of labor according to front wall length of uterus in multipara was 1.58 (95% CI: 0.58–4.26), and front wall length of uterus is not the significant factor that may prolong the duration of the second stage of labor.
Table 11: Relationship between front wall length of uterus and duration of the second stage of labor

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Relationship between perineum height and duration of the second stage of labor

As shown in [Table 12], OR of duration of the second stage of labor according to perineum height in primipara was 1.89 (95% CI: 1.04–3.43), and perineum height is the significant factor that may prolong the duration of the second stage of labor; but OR of duration of the second stage of labor according to perineum height in multipara was 1.05 (95% CI: 0.38–2.91), and perineum height is not the significant factor that may prolong the duration of the second stage of labor.
Table 12: Relationship between perineum height and duration of the second stage of labor

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Relationship between fetal membranes condition and duration of the second stage of labor

As shown in [Table 13], OR of duration of the second stage of labor according to fetal membranes condition in all of primipara and multipara was 2.19 (95% CI: 1.14–4.19) and 3.02 (95% CI: 1.10–8.29), respectively, and fetal membranes condition is the significant factor that may prolong the duration of the second stage of labor.
Table 13: Relationship between fetal membranes condition and duration of the second stage of labor

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Relationship between elapsed period of the first stage of labor and duration of the second stage of labor

As shown in [Table 14], OR of duration of the second stage of labor according to elapsed period of the first stage of labor in primipara was 1.84 (95% CI: 1.03–3.29), and elapsed period of the first stage of labor is the significant factor that may prolong the duration of the second stage of labor; but OR of duration of the second stage of labor according to elapsed period of the first stage of labor in multipara was 1.41 (95% CI: 0.53–3.73), and elapsed period of the first stage of labor is not the significant factor that may prolong the duration of the second stage of labor.
Table 14: Relationship between elapsed period of the first stage of labor and duration of the second stage of labor

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Relationship between parturient's laboratory and ultrasonography findings and duration of the second stage of labor

Relationship between hemoglobin content and duration of the second stage of labor

As shown in [Table 15], OR of duration of the second stage of labor according to hemoglobin content in primipara was 0.46 (95% CI: 0.25–0.84), and hemoglobin content is the significant factor that may prolong the duration of the second stage of labor; but OR of duration of the second stage of labor according to hemoglobin content in multipara was 0.99 (95% CI: 0.38–2.61), and hemoglobin content is not the significant factor that may prolong the duration of the second stage of labor.
Table 15: Relationship between hemoglobin content and duration of the second stage of labor

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Relationship between newborn's body weight and duration of the second stage of labor

As shown in [Table 16], OR of duration of the second stage of labor according to newborn's body weight in primipara was 1.88 (95% CI: 1.05–3.36), and newborn's body weight is the significant factor that may prolong the duration of the second stage of labor; but OR of duration of the second stage of labor according to newborn's body weight in multipara was 1.33 (95% CI: 0.50–3.56), and newborn's body weight is not the significant factor that may prolong the duration of the second stage of labor.
Table 16: Relationship between newborn's body weight and duration of the second stage of labor

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  Discussion Top


Prolonged duration of the second stage of labor increases parturients' complications in all of primipara and multipara, and this is associated with increased perinatal morbidity and mortality.[1],[2] In a research, it was reported that parturients' complications such as chorioamnionitis, uterine atony, and third- or fourth-degree perineal laceration increased because of prolonged duration of the second stage of labor.[3],[4] There are also research data that prolonged duration of the second stage of labor is significantly correlated with postpartum hemorrhage and perineal laceration. Another research showed that brachial plexus paralysis increased if the duration of the second stage of labor was prolonged.[5],[6] Significantly correlated factors with the duration of the second stage of labor are parity, body weight gaining during pregnancy, parturient's height, transverse diameter of pelvic outlet, pubic arch angle, epidural analgesia, and so on.[6],[7],[8],[9],[10] As stated above, parturient and newborn complications increased with prolonged duration of the second stage of labor. Moreover, we can understand that various factors may affect the duration of the second stage of labor. Our research data corresponded with literature data in which the duration of labor of obese women was longer, activity stage of the first stage of labor and the second stage of labor of obese women were prolonged certainly, body weight gaining during pregnancy was a manifest factor prolonging the duration of the second stage of labor, process of labor was affected by parturient's body weight gaining during pregnancy, and parturient's body dimensions played some roles in estimation of the duration of the second stage of labor.[10] All the research results about the effects of parturient's somatic findings on the duration of the second stage of labor show that the factors prolonging the duration of the second stage of labor were age (over 30 years old), height (<155 cm), BMI (>28), and body weight gaining during pregnancy (>8.0 kg) in all of primipara and multipara

When our research data is weighed with literature data[11],[12] in which occiput posterior presentation prolonged the duration of the second stage of labor and increased cesarean section rate and the fact that pregnant uterus is twisted to the right is considered, ROT may be the significant factor prolonging the duration of the second stage of labor. Because second rotation of fetal caput has marked tendency to occiput posterior presentation than occiput anterior presentation in ROT. If the first stage of labor is elapsed at night, the parturient feels very tired because she suffers from pains of childbirth in this period when she has to sleep physiologically; therefore, she is meeting with uterine inertia (weak pains) and the duration of labor is prolonged. All the research results about the effects of parturient's obstetrical examination findings on the duration of the second stage of labor show that the factors prolonging the duration of the second stage of labor contain fetal position in the first stage of labor (ROT) and fetal membrane condition (ruptured) for all of primipara and multipara, a front wall length of uterus (>34 cm), perineum height (>3.6 cm), elapsed period of the first stage of labor (nighttime) for primipa, and interval between present and last delivery (>25 months) and last cesarean section for multipara.

Our research data corresponded with literature data in which the duration of labor was longer in parturient with anemia but did not correspond with literature data in which the duration of labor of anemia of pregnancy was longer in multipara and anemia of pregnancy but did not have an effect on the duration of labor. Our research data corresponded with literature data in which newborn's body weight is the significant factor prolonging the duration of the second stage of labor (P < 0.025), newborn's excessive body weight prolongs the duration of labor, and labor process has to be observed to prevent abnormal labor when newborn's body weight is >3500 g. However, our research data did not correspond with literature data in which there is not any significant difference in delay of the second stage of labor between shoulder dystocia group by giant baby and without that group, and there is not any correlation between newborn's body weight and prolonged duration of the second stage of labor. We think that the reason is because group division by newborn's body weight is different in every researcher. All the research results about the effects of parturient's laboratory and ultrasonography findings on the duration of the second stage of labor showed that the factors prolonging the duration of the second stage of labor contain Hb (<100 g/L) and newborn's body weight (>3.0 kg) for primipara.


  Conclusion Top


The factors prolonging the duration of the second stage of labor are as follows:

  1. The factors prolonging the duration of the second stage of labor contain age (over 30 years old), height (<155 cm), BMI (>28), body weight gaining during pregnancy (>8.0 kg), fetal position in the first stage of labor (ROT), and fetal membrane condition (ruptured) for all of primipara and multipara
  2. The factors prolonging the duration of the second stage of labor contain a front wall length of uterus (>34 cm), perineum height (>3.6 cm), elapsed period of the first stage of labor (night time), Hb (<100 g/L), and newborn's body weight (>3.0 kg) for primipa
  3. The factors prolonging the duration of the second stage of labor contain interval between present and last delivery (>25 months) and last cesarean section for multipara
  4. Among these factors, management possible factors in the first stage of labor are fetal position at the first stage of labor (ROT), elapsed period of the first stage of labor (night time), and fetal membrane condition (ruptured).


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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Prins M, Boxem J, Lucas C, Hutton E. Effect of spontaneous pushing versus valsalva pushing in the second stage of labour on mother and fetus: A systematic review of randomised trials. BJOG 2011;118:662-70.  Back to cited text no. 5
    
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Diegmann EK, Andrews CM, Niemczura CA. The length of the second stage of labor in uncomplicated, nulliparous African American and Puerto Rican women. J Midwifery Womens Health 2000;45:67-71.  Back to cited text no. 7
    
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Robinson BK, Mapp DC, Bloom SL, Rouse DJ, Spong CY, Varner MW, et al. Increasing maternal body mass index and characteristics of the second stage of labor. Obstet Gynecol 2011;118:1309-13.  Back to cited text no. 10
    
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Chou MR, Kreiser D, Taslimi MM, Druzin ML, El-Sayed YY. Vaginal versus ultrasound examination of fetal occiput position during the second stage of labor. Am J Obstet Gynecol 2004;191:521-4.  Back to cited text no. 11
    
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Sherer DM, Miodovnik M, Bradley KS, Langer O. Intrapartum fetal head position II: Comparison between transvaginal digital examination and transabdominal ultrasound assessment during the second stage of labor. Ultrasound Obstet Gynecol 2002;19:264-8.  Back to cited text no. 12
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10], [Table 11], [Table 12], [Table 13], [Table 14], [Table 15], [Table 16]



 

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