{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T18:09:00Z","timestamp":1793383740592,"version":"4.5.0"},"reference-count":14,"publisher":"Georg Thieme Verlag KG","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Objective\u2003The aim of this study is to assess the impact of a prolonged second stage of labor on maternal and neonatal outcomes by comparing women who had expectant management versus operative intervention beyond specified timeframes in the second stage of labor.<\/jats:p><jats:p>\n          Study Design\u2003Retrospective cohort including live singletons at \u226536 weeks who reached the second stage of labor. Expectant management (second stage &gt;3, 2, 2, and 1\u2009hour in nulliparas with an epidural, nulliparas without an epidural, multiparas with an epidural, and multiparas without an epidural, respectively) was compared with those who had an operative delivery (vaginal or cesarean) prior to these timeframes. The primary maternal outcome was a composite of postpartum hemorrhage, chorioamnionitis, operative complications, postpartum infections, and intensive care unit admission. The primary neonatal outcome was a composite of cord blood acidemia, 5-minute Apgar's score &lt;5, chest compressions or intubation at birth, sepsis, seizures, birth injury, death, transfer to a long-term care facility, and respiratory support for &gt;1 day.<\/jats:p><jats:p>\n          Results\u2003Among 218 women, 115 (52.8%) had expectant management. Expectant management was associated with a significantly increased risk of the maternal composite (adjusted odds ratio [aOR]: 1.99, 95% confidence interval [CI]: 1.09\u20133.64) but not the neonatal composite (aOR: 1.54, 95% CI: 0.71\u20133.35).<\/jats:p><jats:p>\n          Conclusion\u2003Expectant management of a prolonged second stage was associated with a higher rate of adverse maternal outcomes, but the rate of adverse neonatal outcomes was not significantly increased.<\/jats:p>","DOI":"10.1055\/s-0040-1708799","type":"journal-article","created":{"date-parts":[[2020,3,24]],"date-time":"2020-03-24T23:40:42Z","timestamp":1585093242000},"page":"1201-1207","source":"Crossref","is-referenced-by-count":8,"title":["Perinatal Outcomes with Longer Second Stage of Labor: A Risk Analysis Comparing Expectant Management to Operative Intervention"],"prefix":"10.1055","volume":"37","author":[{"given":"Elizabeth B.","family":"Ausbeck","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara F.","family":"Jennings","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Macie","family":"Champion","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meredith","family":"Gray","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Blanchard","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan T.","family":"Tita","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorie M.","family":"Harper","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2020,3,24]]},"reference":[{"issue":"01","key":"ref1","first-page":"1","article-title":"Births: final data for 2015","volume":"66","author":"J A Martin","year":"2017","journal-title":"Natl Vital Stat Rep"},{"issue":"04","key":"ref2","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":"06","key":"ref3","doi-asserted-by":"crossref","first-page":"1267","DOI":"10.1097\/AOG.0b013e3181df925f","article-title":"Vaginal birth after cesarean: new insights on maternal and neonatal outcomes","volume":"115","author":"J M Guise","year":"2010","journal-title":"Obstet 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nulliparous women with epidural analgesia","volume":"201","author":"C Le Ray","year":"2009","journal-title":"Am J Obstet Gynecol"},{"issue":"06","key":"ref13","doi-asserted-by":"crossref","first-page":"1248","DOI":"10.1097\/AOG.0b013e3181a722d6","article-title":"Maternal and perinatal outcomes with increasing duration of the second stage of labor","volume":"113","author":"V M Allen","year":"2009","journal-title":"Obstet Gynecol"},{"issue":"01","key":"ref14","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"}],"container-title":["American Journal of 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