General obstetrics

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Indicators for intervention during the expulsive second-stage arrest of labour

  1. E Leushuis1,2,3,
  2. M Tromp2,
  3. ACJ Ravelli2,
  4. AM van Huis1,
  5. BW Mol1,
  6. GHA Visser4,
  7. JAM van der Post1

Article first published online: 13 OCT 2009

DOI: 10.1111/j.1471-0528.2009.02378.x

Issue

BJOG: An International Journal of Obstetrics & Gynaecology

BJOG: An International Journal of Obstetrics & Gynaecology

Volume 116, Issue 13, pages 1773–1781, December 2009

Additional Information

How to Cite

Leushuis, E., Tromp, M., Ravelli, A., van Huis, A., Mol, B., Visser, G. and van der Post, J. (2009), Indicators for intervention during the expulsive second-stage arrest of labour. BJOG: An International Journal of Obstetrics & Gynaecology, 116: 1773–1781. doi: 10.1111/j.1471-0528.2009.02378.x

Author Information

  1. 1

    Department of Gynaecology and Obstetrics

  2. 2

    Department of Medical Informatics, Amsterdam Medical Center, Amsterdam, the Netherlands

  3. 3

    Department of Gynaecology and Obstetrics, Vrije Universiteit Medical Center, Amsterdam, the Netherlands

  4. 4

    Department of Gynaecology and Obstetrics, Universal Medical Center Utrecht, Utrecht, the Netherlands

*E Leushuis, Research Fellow, Department of Obstetrics/Gynaecology, Room H4-238, Meibergdreef 9, 1105 DE Amsterdam, the Netherlands. Email e_leushuis@hotmail.com

Publication History

  1. Issue published online: 11 NOV 2009
  2. Article first published online: 13 OCT 2009
  3. Accepted 22 August 2009. Published Online 13 October 2009.

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Keywords:

  • Arrest in labour;
  • cohort study;
  • multivariable analysis;
  • second stage

Objective  To identify antepartum and intrapartum indicators of obstetric interventions during the expulsive second-stage arrest of labour.

Design  Retrospective cohort study.

Setting  The Netherlands.

Population  A cohort of 389 086 women with singleton, cephalic, term, live-birth deliveries from 2002 to 2004 who had entered the expulsive second stage of labour. Of all these deliveries, 37 899 (9.7%) were complicated by expulsive second-stage arrest of labour. Women with a prior Caesarean section or women undergoing an elective Caesarean section were excluded.

Methods  All deliveries in the Netherlands from 2002 to 2004 were registered in the Netherlands Perinatal Registry, which contains the linked and validated data of three databases. Uni- and multivariable logistic regression analyses were performed.

Main outcome measures  Ante- and intrapartum indicators for interventions during expulsive second-stage arrest of labour.

Results  Primiparous delivery was the most important antepartum indicator for intervention during expulsive second-stage arrest. Using multivariable analysis the following antepartum indicators were associated with intervention for expulsive second-stage arrest of primiparous labour: maternal age, gestational age, diabetes, hypertension and labour induction. Prominent intrapartum indicators for primiparous deliveries were fetal head position and oxytocin augmentation.

Conclusion  Multiple significant antepartum and intrapartum indicators associated with intervention for expulsive second-stage arrest of labour were identified in this large retrospective study. Prominent were the associations of parity, maternal age and fetal head position with expulsive second-stage arrest. The identified factors should be further evaluated in prospective studies that aim to develop prediction models.

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