Pushing for over 2 hours during delivery increases maternal, neonatal morbidity
MedWire News: Researchers question whether women experiencing an active second stage of labor of over 2 hours should continue with expulsive efforts, as the chance of a spontaneous vaginal delivery decreases and the risk for maternal morbidity significantly increases.
Camille Le Ray (INSERM, Paris, France) and co-authors performed a secondary analysis of the Pushing Early or Pushing Late with Epidural trial that included 1,862 nulliparous women with epidural analgesia who were in the second stage of labor.
Compared with women pushing for under 1 hour, those pushing 1-2 hours, 2-3 hours, and over 3 hours had a 60, 90, and 97 percent decreased likelihood of spontaneously delivering an infant with no signs of asphyxia.
The number of women experiencing intrapartum fever was also significantly higher, with corresponding values of 3.3, 6.3, 8.8, and 12.3 percent, respectively.
Postpartum hemorrhage occurred in 23.6 percent of women who did not deliver after 2 hours of active pushing, and increased to 30.5 percent of women after 3 hours, with corresponding odds ratios (ORs) of 1.6 and 2.5 compared with women pushing for under 1 hour.
However, the authors caution that only a randomized controlled trial comparing neonatal and maternal outcomes between women pushing up to 2 hours and those pushing with no fixed limit will answer the question of when to stop pushing.
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By Ingrid Grasmo