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Deprecated: Implicit conversion from float 213.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Birth 2015 ; 42 (1): 86-93 Nephropedia Template TP
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Influence of the duration of the second stage of labor on the likelihood of obstetric anal sphincter injury #MMPMID25439012
AIKEN CE; AIKEN AR; PRENTICE A
Birth 2015[Mar]; 42 (1): 86-93 PMID25439012show ga
Background: Duration of the second stage of labor has been suggested as an independent risk factor for clinically detectable obstetric anal sphincter injury in low-risk nulliparous women. Methods: A retrospective 5-year cohort study in a UK obstetrics center including high-risk delivery unit and low-risk birthing center. 4831 nulliparous women with vertex-presenting, single, live-born infants at term were included. The cohort was stratified according to spontaneous or instrumental delivery. Binary logistic regression models were used to examine the association between duration of second stage and sphincter injury. Results: 325 of 4831 women (6.7%) sustained sphincter injuries. In spontaneously delivering women, there was no association between duration of the second stage and the likelihood of sustaining sphincter injuries. Factors associated with increased likelihood of sustaining sphincter injury included older maternal age, higher birthweight and Southeast Asian ethnicity. By contrast, for women undergoing instrumental delivery, a longer second stage was associated with an increased sphincter injury risk of 6% per 15 minutes in the second stage of labor prior to delivery. Conclusions: For spontaneous vaginal deliveries, duration of the second stage of labor is not an independent risk factor for obstetric anal sphincter injuries. The association between prolonged second stage and sphincter injury for instrumental deliveries is likely explained by the risk posed by the use of the instruments themselves or by delay in initiating instrumental assistance. Attempts to modify the duration of the second stage for prevention of sphincter injuries are unlikely to be beneficial and may be detrimental.