| How does the duration of active pushing in labor affect neonatal outcomes? | |
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MedLine Citation:
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PMID: 22098306 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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Abstract Aim: To assess the effect of time of active pushing (TAP) on neonatal outcome. Materials and methods: The study population (n=36,432) was taken from a Swedish randomized control trial on intrapartum monitoring, a European Union fetal electrocardiogram trial, and from Mölndal Hospital. After validation of acid-base samples and TAP, 22,812 cases were accepted for analysis. Results: The median active TAP was 36 min for P0 and 13 min for P≥1 (P<0.001). After adjustments for parity, epidural, labor induction, birth weight, and gender, pushing for 15-29 min (n=6589) relative to pushing for <15 min (n=7264) increased the OR of a cord artery pH of <7.00 to 3.20 (95% CI 1.7-6.0), and that of a base deficit in extracellular fluid of >12 mmol/L to 3.5 (95% CI 1.3-9.0). The group with a cord artery pH of <7.00 had a longer TAP than the group with pH≥7.00: median (5(th)-95(th)percentile), 38 (9-107) min vs. 23 (5-87) min, P<0.001. The probability of a spontaneous vaginal delivery decreased significantly with every subsequent increase of 30 min in TAP (P<0.05). Conclusion: The risks of severe acidemia, metabolic acidosis, and deteriorated neonatal outcome gradually increased with the length of TAP (>15 min), while the probability of a spontaneous vaginal delivery decreased with the duration of pushing. We suggest active physiological evaluation of the labor progress together with continuous electronic fetal monitoring during pushing irrespective of guideline thresholds. |
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Authors:
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Branka M Yli; Grete A Birkeland Kro; Svein Rasmussen; Janette Khoury; Håkan Norèn; Isis Amer-Wåhlin; Ola Didrik Saugstad; Babill Stray-Pedersen |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-11-18 |
Journal Detail:
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Title: Journal of perinatal medicine Volume: - ISSN: 1619-3997 ISO Abbreviation: - Publication Date: 2011 Nov |
Date Detail:
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Created Date: 2011-11-21 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0361031 Medline TA: J Perinat Med Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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Women and Children's Division, Oslo University Hospital Rikshospitalet and Institute of Clinical Medicine, University of Oslo, Oslo, Norway. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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