23 May 2025 • A large study of 55,309 primiparous births linked prolonged second stage of labor—over 3 hours with anesthesia or 2 hours without—to significantly worse maternal and neonatal outcomes.

Key Findings:

• Delivery outcomes: Cesarean rates rose (8.5% vs. 0.8%) and instrumental delivery increased (43.1% vs. 13.6%), and spontaneous vaginal birth declined (48.4% vs. 85.6%).
• Maternal risks: Higher risk of postpartum hemorrhage (1.1 % vs. 0.8 %) and severe perineal tears (1.8 % vs. 1.0 %).
• Neonatal risks: increased shoulder dystocia (0.5 % vs. 0.1 %), NICU stays more than 72 hours (3.6 % vs. 2.4 %), clavicular fractures (0.7 % vs. 0.4 %), and 5-minute Apgar scores < 7 (1.3 % vs. 0.7 %).
• Composite outcomes: Odds of maternal and neonatal outcomes rose (OR 2.2 and OR 1.1, respectively).

These findings underscore the importance of timely obstetric decision-making to help mitigate these risks.

Source: EJOG | Read Full Story