Prolonged second stage of labor and risk of subsequent spont
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Preterm birth is the leading cause of neonatal morbidity and death. Although many risk factors for spontaneous preterm birth have been elucidated, some women with a previous term delivery experience spontaneous preterm birth in the absence of any identifiable risk factors. Cervical trauma during a prolonged second stage of labor has been postulated as a potential contributor to subsequent spontaneous preterm birth.

A total of 1032 women met the criteria for study inclusion, with an overall subsequent spontaneous preterm birth rate of 3.1%. The prolonged second stage of labor of 4 hours was identified in 24.4% of the cohort, with 70.6% of this group delivering vaginally. There was no statistically significant difference in rate of spontaneous preterm birth in those with and without prolonged second stage of labor. A very prolonged second stage of labor of 7 hours was identified in 4.3% (44/1032 women) of the cohort, with 45.4% (20/44 women) of this group delivering vaginally. There was a significantly higher rate of spontaneous preterm birth in those with very prolonged second stage of labor compared with those without prolonged labor, although this finding did not persist after controlled for the mode of first delivery. Spontaneous preterm birth after very prolonged second stage of labor was identified in only 4 patients, all of whom had a cesarean delivery with the first pregnancy.

A second stage of labor of more than 4 hours in the first pregnancy was not associated with an increased risk of subsequent spontaneous preterm birth and was associated with a high rate of vaginal birth. A second stage of labor of more than 7 hours did not appear to be associated with an increased risk of preterm birth, when adjustments made for mode of first delivery. There was a nonsignificant increase in the risk of preterm birth in those who delivered via cesarean section after a second stage of labor of 7 hours.

Source: https://www.sciencedirect.com/science/article/pii/S2589933320300136
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