An analysis of second-stage labor beyond 3 hours in nulliparous women

April T. Bleich, James M. Alexander, Donald D. McIntire, Kenneth J. Leveno

Research output: Contribution to journalArticlepeer-review

40 Scopus citations


ObjectiveTo analyze outcomes after second-stage labor beyond 3 hours and determine if prolonged second stages were intentional. Study DesignRetrospective cohort analysis of maternal and neonatal outcomes in nulliparous women based on second-stage duration. Medical records were reviewed for management decisions in women with second stages 4 hours; all other outcomes were accessed via computerized obstetric database. ResultsSecond stage exceeding 3 hours occurred in 1489 (7%) of 21,991 pregnancies analyzed. Of the 427 (2%) with second stages 4 hours, 315 (74%) reached 4 hours unintentionally, after a decision for operative delivery had been made. Only 34 (8%) women were intentionally allowed to continue second-stage labor beyond 4 hours, and half of these ultimately required cesarean. Indices of maternal and neonatal morbidity were significantly increased when second stages exceeded 3 hours. ConclusionMost second stages reaching 4 hours are unintentional, occurring while awaiting an previously decided upon operative delivery. Maternal and neonatal morbidities are significantly increased with second stages beyond 3 hours.

Original languageEnglish (US)
Pages (from-to)717-722
Number of pages6
JournalAmerican Journal of Perinatology
Issue number9
StatePublished - 2012


  • intentional
  • prolonged
  • second stage labor

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology


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