{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T15:13:52Z","timestamp":1747149232413,"version":"3.40.5"},"reference-count":25,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2023,5,13]],"date-time":"2023-05-13T00:00:00Z","timestamp":1683936000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp; Obste"],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate the effects of extending the second stage of labor in women attempting a trial of labor after a cesarean section (TOLAC).<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>A retrospective cohort study comparing maternal and neonatal outcomes following TOLAC over two periods: period I whose prolonged second stage was considered 2\u2009h, and period II whose prolonged second stage was considered 3\u2009h. The primary outcome was repeat cesarean delivery (CD) rate.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Incidence of repeat CD was significantly lower in period II (18.1% vs 29.7%, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). Incidence of uterine rupture was significantly higher in period II (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). Instrumental delivery rates were significantly higher in period II (26.2% vs 15.6%, odds ratio [OR] 1.67, 95% CI 1.21\u20133.56, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). Rates of third\u2010 and fourth\u2010degree perineal lacerations, chorioamnionitis, and length of hospital stay were similar between groups. Incidence of fetal acidemia was significantly higher in period II (1.5% vs 0.7%, OR 2.14, 95% CI 1.32\u20135.63, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), and incidence of neonatal intensive care unit (NICU) admission was significantly higher (2.5% vs 1.6%, <jats:italic>P<\/jats:italic>\u2009=\u20090.004).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Extension of the second stage of labor is associated with a decrease in repeat CD rate with a concomitant increase in instrumental delivery rates, uterine rupture, fetal acidemia, and NICU admissions. These findings may warrant further consideration of allowing a prolonged second stage in patients attempting TOLAC.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ijgo.14855","type":"journal-article","created":{"date-parts":[[2023,5,13]],"date-time":"2023-05-13T07:20:05Z","timestamp":1683962405000},"page":"594-600","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The impact of extending the second stage of labor on repeat cesarean section and maternal and neonatal outcome"],"prefix":"10.1002","volume":"163","author":[{"given":"Roy","family":"Lauterbach","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Rambam Health Care Campus  Haifa Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2327-3402","authenticated-orcid":false,"given":"Naphtali","family":"Justman","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and 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