Women undergoing labor with a longer second stage after prior cesarean delivery (CD) may achieve successful vaginal delivery, however these patients may also be at increased risk of adverse maternal outcomes and should be observed closely for fetal heart monitoring, maternal viral signs, and symptoms suggestive of uterine rupture or dehiscence. This according to a secondary analysis of a prospective observational cohort study that assessed outcomes in women with a prior uterine scar and included women with a previous CD without prior vaginal delivery who reached the second stage of labor. The primary outcome was mode of delivery by second-stage duration. Researchers found:
- Of 4,579 women with a previous CD who reached the second stage of labor, 4,147 (90.6%) delivered vaginally.
- Successful vaginal delivery rates decreased as second stage increased.
- Risk of all adverse maternal outcomes increased with the length of the second stage.
- Risk of neonatal outcomes did not differ significantly by second-stage length.
Hehir MP, Rouse DJ, Miller RS, et al. Second-stage duration and outcomes among women who labored after a prior cesarean delivery. [Published online ahead of print February 5, 2018]. Obstet Gynecol. doi:10.1097/AOG.0000000000002478.