{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T08:33:53Z","timestamp":1740126833150,"version":"3.37.3"},"reference-count":17,"publisher":"Georg Thieme Verlag KG","issue":"S 01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:p>\n            Objective\u2003The aim of the study is to analyze maternal morbidity in the second stage of labor in a manner that approximates clinical choice.<\/jats:p><jats:p>\n            Study Design\u2003The study design comprises secondary analysis of the Consortium for Safe Labor, which included 228,688 deliveries at 19 hospitals between 2002 and 2008. We included the 107,675 women who were undergoing a trial of labor without a prior uterine scar or history of substance abuse, who reached the second stage, with a liveborn, nonanomalous, vertex, singleton, at term of at least 2,500\u2009g. Maternal complications included postpartum fever, hemorrhage, blood transfusion, thrombosis, intensive care unit (ICU) admission, hysterectomy, and death. For maternal complications, we simulated the clinical choice by comparing operative vaginal or cesarean deliveries to continued expectant management at every hour in the second stage. For neonatal complications, we modeled the risk of severe neonatal complication by second stage duration for spontaneous vaginal deliveries only, adjusting for maternal demographics, comorbidities, and delivery hospital. Severe neonatal complications included death, asphyxia, hypoxic-ischemic encephalopathy (HIE), seizure, sepsis with prolonged stay, need for mechanical ventilation, and 5-minute Apgar score &lt;4.<\/jats:p><jats:p>\n            Results\u2003Maternal morbidity was higher with operative vaginal\/cesarean delivery versus continued expectant management for every hour in the second stage, a difference that was statistically significant at hour 2 (18.4 vs. 14.7%; p &lt;0.01). Overall, 951 (0.88%) deliveries were complicated by a severe neonatal complication. A second stage over 4\u2009hours was associated with an adjusted odds of severe neonatal complication of 2.10 (95% confidence interval [CI]: 1.32\u20133.34) as compared with women who delivered in the first hour.<\/jats:p><jats:p>\n            Conclusion\u2003There is a trade-off between maternal and neonatal morbidity in the second stage of labor. Serious neonatal complications rise throughout, however, there is no time at which maternal morbidity is improved with a cesarean or operative vaginal delivery. Strategies are needed to identify neonates at highest risk of complication for targeted intervention.<\/jats:p><jats:p>\n            Key Points\n          <\/jats:p>","DOI":"10.1055\/a-1877-8770","type":"journal-article","created":{"date-parts":[[2022,6,16]],"date-time":"2022-06-16T22:36:47Z","timestamp":1655419007000},"page":"e312-e317","source":"Crossref","is-referenced-by-count":0,"special_numbering":"S","title":["Maternal Morbidity in the Second Stage of Labor: Analysis to Simulate the Clinical Choice"],"prefix":"10.1055","volume":"41","author":[{"given":"Sarah E.","family":"Little","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5568-4444","authenticated-orcid":false,"given":"Mark A.","family":"Clapp","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine, Massachusetts General Hospital, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Lassey","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Radek","family":"Bukowski","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine, University of Texas, Austin, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"Jr","given":"William H.","family":"Barth","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine, Massachusetts General Hospital, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julian","family":"Robinson","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2022,9,12]]},"reference":[{"issue":"124","key":"ref1","first-page":"1","article-title":"Changes in cesarean delivery rates by gestational age: United States, 1996-2011","author":"M J Osterman","year":"2013","journal-title":"NCHS Data Brief"},{"issue":"05","key":"ref2","doi-asserted-by":"crossref","first-page":"1181","DOI":"10.1097\/AOG.0b013e3182704880","article-title":"Preventing the first cesarean delivery: summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, and American College of Obstetricians and Gynecologists Workshop","volume":"120","author":"C Y Spong","year":"2012","journal-title":"Obstet Gynecol"},{"issue":"03","key":"ref3","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/j.ajog.2014.01.026","article-title":"Safe prevention of the primary cesarean delivery","volume":"210","author":"A B Caughey","year":"2014","journal-title":"Am J Obstet Gynecol"},{"issue":"01","key":"ref4","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1097\/AOG.0000000000000278","article-title":"Neonatal and maternal outcomes with prolonged second stage of labor","volume":"124","author":"S K Laughon","year":"2014","journal-title":"Obstet Gynecol"},{"issue":"04","key":"ref5","doi-asserted-by":"crossref","first-page":"357.e1","DOI":"10.1016\/j.ajog.2009.08.003","article-title":"Second-stage labor duration in nulliparous women: relationship to maternal and perinatal outcomes","volume":"201","author":"D J Rouse","year":"2009","journal-title":"Am J Obstet Gynecol"},{"issue":"02","key":"ref6","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1097\/AOG.0000000000002431","article-title":"Reassessing the duration of the second stage of labor in relation to maternal and neonatal morbidity","volume":"131","author":"K L Grantz","year":"2018","journal-title":"Obstet Gynecol"},{"issue":"02","key":"ref7","doi-asserted-by":"crossref","first-page":"191.e1","DOI":"10.1016\/j.ajog.2018.10.028","article-title":"The impact of extending the second stage of labor to prevent primary cesarean delivery on maternal and neonatal outcomes","volume":"220","author":"Y Zipori","year":"2019","journal-title":"Am J Obstet Gynecol"},{"issue":"03","key":"ref8","doi-asserted-by":"crossref","first-page":"361.e1","DOI":"10.1016\/j.ajog.2015.12.042","article-title":"Randomized controlled trial of prolonged second stage: extending the time limit vs usual guidelines","volume":"214","author":"A C Gimovsky","year":"2016","journal-title":"Am J Obstet Gynecol"},{"issue":"06","key":"ref9","doi-asserted-by":"crossref","first-page":"689.e1","DOI":"10.1016\/j.ajog.2017.10.007","article-title":"New labor management guidelines and changes in cesarean delivery patterns","volume":"217","author":"J I Rosenbloom","year":"2017","journal-title":"Am J Obstet Gynecol"},{"issue":"04","key":"ref10","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1016\/j.ajog.2015.10.926","article-title":"Second-stage labor: how long is too long?","volume":"214","author":"K J Leveno","year":"2016","journal-title":"Am J Obstet Gynecol"},{"issue":"03","key":"ref11","doi-asserted-by":"crossref","first-page":"100028","DOI":"10.1016\/j.ajogmf.2019.07.001","article-title":"Pushing the bounds of second stage in term nulliparas with a predictive model","volume":"1","author":"A C Gimovsky","year":"2019","journal-title":"Am J Obstet Gynecol MFM"},{"issue":"04","key":"ref12","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1503\/cmaj.060870","article-title":"Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term","volume":"176","author":"S Liu","year":"2007","journal-title":"CMAJ"},{"issue":"02","key":"ref14","doi-asserted-by":"crossref","first-page":"e1919498","DOI":"10.1001\/jamanetworkopen.2019.19498","article-title":"Patient and hospital factors associated with unexpected newborn complications among term neonates in US hospitals","volume":"3","author":"M A Clapp","year":"2020","journal-title":"JAMA Netw Open"},{"issue":"04","key":"ref15","doi-asserted-by":"crossref","first-page":"395.e1","DOI":"10.1016\/j.ajog.2019.02.001","article-title":"Unexpected term NICU admissions: a marker of obstetrical care quality?","volume":"220","author":"M A Clapp","year":"2019","journal-title":"Am J Obstet Gynecol"},{"issue":"04","key":"ref16","doi-asserted-by":"crossref","first-page":"326.e1","DOI":"10.1016\/j.ajog.2010.06.058","article-title":"Contemporary cesarean delivery practice in the United States","volume":"203","author":"J Zhang","year":"2010","journal-title":"Am J Obstet Gynecol"},{"issue":"12","key":"ref17","doi-asserted-by":"crossref","first-page":"1201","DOI":"10.1055\/s-0040-1708799","article-title":"Perinatal outcomes with longer second stage of labor: a risk analysis comparing expectant management to operative intervention","volume":"37","author":"E B Ausbeck","year":"2020","journal-title":"Am J Perinatol"},{"issue":"06","key":"ref18","doi-asserted-by":"crossref","first-page":"1226","DOI":"10.1097\/01.AOG.0000219750.79480.84","article-title":"Maternal morbidity associated with multiple repeat cesarean deliveries","volume":"107","author":"R M Silver","year":"2006","journal-title":"Obstet Gynecol"}],"container-title":["American Journal of Perinatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-1877-8770.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T13:09:52Z","timestamp":1730812192000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-1877-8770"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,16]]},"references-count":17,"journal-issue":{"issue":"S 01","published-online":{"date-parts":[[2024,5,13]]},"published-print":{"date-parts":[[2024,5]]}},"URL":"https:\/\/doi.org\/10.1055\/a-1877-8770","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0735-1631","1098-8785"],"issn-type":[{"type":"print","value":"0735-1631"},{"type":"electronic","value":"1098-8785"}],"subject":[],"published-other":{"date-parts":[[2022,6,16]]},"published":{"date-parts":[[2022,6,16]]}}}