Document Detail

When to stop pushing: effects of duration of second-stage expulsion efforts on maternal and neonatal outcomes in nulliparous women with epidural analgesia.
MedLine Citation:
PMID:  19788968     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: The purpose of this study was to assess the influence of the duration of active second-stage labor on maternal and neonatal outcomes. STUDY DESIGN: Secondary analysis of the Pushing Early Or Pushing Late with Epidural trial that included 1862 nulliparous women with epidural analgesia who were in the second stage of labor. According to duration of active second-stage labor, we estimated the proportion of spontaneous vaginal deliveries (SVD) with a newborn infant without signs of asphyxia (5-minute Apgar score > or =7 and arterial pH >7.10). We also analyzed maternal and neonatal outcomes according to the duration of expulsive efforts. RESULTS: Relative to the first hour of expulsive efforts, the chances of a SVD of a newborn infant without signs of asphyxia decreased significantly every hour (1- to 2-hour adjusted odds ratio, 0.4; 95% confidence interval [CI], 0.3-0.6; 2- to 3-hour adjusted odds ratio, 0.1; 95% CI, 0.09-0.2; >3-hour adjusted odds ratio, 0.03; 95% CI, 0.02-0.05). The risk of postpartum hemorrhage and intrapartum fever increased significantly after 2 hours of pushing. CONCLUSION: Faced with a decreasing probability of SVD and increased maternal risk of morbidity after 2 hours, we raise the question as to whether expulsive efforts should be continued after this time.
Camille Le Ray; François Audibert; François Goffinet; William Fraser
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  American journal of obstetrics and gynecology     Volume:  201     ISSN:  1097-6868     ISO Abbreviation:  Am. J. Obstet. Gynecol.     Publication Date:  2009 Oct 
Date Detail:
Created Date:  2009-09-30     Completed Date:  2009-10-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370476     Medline TA:  Am J Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  361.e1-7     Citation Subset:  AIM; IM    
Department of Obstetrics and Gynecology, Sainte Justine Hospital, University of Montréal, Montreal, QC, Canada.
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MeSH Terms
Analgesia, Epidural
Analgesia, Obstetrical
Delivery, Obstetric
Fever / epidemiology
Labor Stage, Second*
Multivariate Analysis
Postpartum Hemorrhage / epidemiology
Pregnancy Outcome*
Risk Factors
Time Factors
Young Adult
Comment In:
Am J Obstet Gynecol. 2009 Oct;201(4):337-8   [PMID:  19788964 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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