(715) Is second stage of labor duration associated with adverse outcomes among forceps assisted vaginal deliveries?

Friday, February 10, 2023

10:30 AM – 12:00 PM

Objective: Previous studies have suggested that both precipitous labor and increased duration of second stage of labor are risk factors for obstetric anal sphincter injury (OASIS) at time of vaginal delivery. We sought to assess if increasing duration of second stage of labor is associated with OASIS in patients undergoing forceps assisted vaginal delivery (FAVD).

Study Design: This retrospective cohort study included patients with term singleton gestations who underwent FAVD at one institution between 2017-2021. The primary outcome was OASIS. Secondary outcomes included quantitative blood loss (QBL), composite of neonatal sub-galeal and cephalohematoma (adverse neonatal composite), and NICU admission. Duration of the second stage of labor was defined continuously in minutes. Mann-Whitney U test was used for outcomes OASIS, Adverse Neonatal Composite, and NICU admission. Pearson Correlation was used for QBL. Univariate random-intercept logistic regression models were also done.

Results:

Of the 983 patients, 899 records had available length of second stage of labor. Of these patients, 170 (18.9%) had OASIS. Overall patient demographics are listed in Table 1. Increasing length of second stage of labor was associated with increased odds of OASIS (OR 1.004 [1.002-1.006], Table 2). Adverse neonatal composite was associated with longer length of second stage (1.002 [1.000, 1.004], Table 2). Additionally, longer length of second stage was associated with increasing QBL (Pearson rho=0.12, [0.05,0.18], p=0.0004). Increasing length of second stage of labor was not associated with NICU admission (1.000 [0.997, 1.002], Table 2).

Conclusion: Adverse outcomes of FAVD, including OASIS, adverse neonatal composite, and QBL are associated with increased duration of second stage of labor. These factors should be considered when managing the second stage of labor.

Primary & Presenting Author(s)

Elizabeth Cochrane, MD (she/her/hers)
Mount Sinai Hospital
New York, New York, United States

Coauthor(s)

TD
Tahera Doctor, BS
Icahn School of Medicine at Mount Sinai
New York, New York, United States
SR
Sarah Roger, BS, MD
Icahn School of Medicine at Mount Sinai
New York, New York, United States
CS
Catherine Stratis, BA
Icahn School of Medicine at Mount Sinai
New York, New York, United States
CG
Chloe Getrajdman, MD
Icahn School of Medicine at Mount Sinai
New York, New York, United States
KW
Kelly Wang, MPH
Icahn School of Medicine at Mount Sinai
New York, New York, United States
GS
Guillaume Stoffels, PhD
Statistician
Icahn School of Medicine at Mount Sinai
New York, New York, United States
Camila Cabrera, MD (she/her/hers)
MFM Fellow
Mount Sinai Hospital
New York, New York, United States
NT
Nicola Tavella, MPH
Research Coordinator
Icahn School of Medicine at Mount Sinai
New York, New York, United States
Daniel Kuhr, MD
Resident Physician
University Hospitals Cleveland Medical Center, Case Western Reserve University
Cleveland, Ohio, United States
LV
Luciana Vieira, MD
Mount Sinai Hospital
New York, New York, United States
AB
Angela Bianco, MD
Attending Physician
Mount Sinai Medical Center
New York, New York, United States
Chelsea A. DeBolt, MD
MFM Fellow
Icahn School of Medicine at Mount Sinai
New York, New York, United States