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PROLONGED SECOND STAGE OF LABOUR,

MATERNAL INFECTIOUS DISEASE, URINARY
RETENTION AND OTHER COMPLICATIONS IN
THE EARLY POSTPARTUM PERIOD

Advisor: dr. Juhesni, Sp.OG (K)

Presented by: Nafa Maulidina
KEPANITERAAN KLINIK SENIOR ILMU KEBIDANAN DAN KANDUNGAN
FAKULTAS KEDOKTERAN UNIVERSITAS ABDURRAB
RSUD
2020
Introduction
Prolonged second stage of labour is
usually defined as 2–3 hours for
primiparous women and 1–2 hours
for parous women.

This has been associated with

increased risk of maternal
morbidity and complications*

Several pregnancy characteristics

associated with both duration of second
stage of labour and risk of maternal
complications**
Introduction

Objective: this study will examine the association

between duration of second stage of labour and
maternal complications during in‐hospital care, such as
infection, urinary retention, haematoma or ruptured
sutures
Methods
Design: population‐based cohort study

Sample : 72.593 vaginal births at 37 weeks of

gestation or later of singleton infants in cephalic
presentation from Stockholm‐Gotland Obstetric
Database*
•Data from 2008 through to 2012
•Exclusion criterion: patients with no partograph
record for time of retracted cervix

Settings : obstetric care unit across

Sweden
Methods
• Operational definition:
▫ Second stage of labour  time in minutes from the
first notation of a fully retracted cervix until delivery
▫ Categorized into 5 groups: <1 hour (reference); 1 to <2
hours; 2 to <3 hours; 3 to <4 hours; and ≥4 hours
▫ Outcomes  diagnosis of maternal complications in
the early postpartum period
▫ Categorized as*: a) infections, b) urinary retention, c)
haematoma in birth canal or ruptured perineal
sutures, and d) any of this complication
Methods
• Other variable
▫ Maternal age at delivery
▫ Maternal height
▫ Body mass index
▫ Cigarette smoking
▫ Cohabitation
▫ Delivery and infant characteristics*
Methods

Statistical analysis:
• Logistic regression: crude odds ratios and adjusted odds
ratios (aOR)*
•P‐value of <0.05 was considered statistically significant
•Women with missing data were not included in the
analysis
Results
Table 1. Maternal and delivery characteristics, and rate of any
maternal complication in the early postpartum period
Table 1. Maternal and delivery characteristics, and rate of any
maternal complication in the early postpartum period (cont)
Table 1. Maternal and delivery characteristics, and rate of any
maternal complication in the early postpartum period (cont)
Results
• Total 72.593 vaginal births at ≥37 weeks of
gestation of singleton infants in cephalic
presentation in the Stockholm‐Gotland Obstetric
Database were included in this study
• Rates of complications increased with time from
retracted cervix to birth
• Rate of any complication:
• Parous women w/ previous c-sect  7.3%
• Primiparous women  4,8%
• Parous women without previous c-sect  1.7%
Results
• Variables associated w/ ↑ maternal complications:
• Induced deliveries
• Epidural analgesia
• Oxytocin augmentation during labour
• Instrumental delivery
• Advanced gestational age
• There was a significant interaction between parity and
duration of second stage of labour w/ respect to risk of
maternal complications in the early postpartum period
Results
• Risk of any maternal complication generally ↑ with the
duration of second stage of labour
• Risk of maternal complication for a duration of second
stage of labour between 2 and <3 hours:*
• 50% for primiparous and parous women w/ previous c-sect
• 3 fold for parous women without previous c-sect
• Risk of maternal infectious disease and urinary retention ↑
with duration of labour
Table 2. Time from retracted cervix to vaginal delivery and risks of
maternal complications during the early postpartum period
Results
• Rates of maternal complication were higher in:
• Non-instrumental deliveries
• Duration of second stage (in both group)
• Overall rates of maternal complication in non-
instrumental deliveries:
• Parous women w/ previous c-sect  6.0%*
• Parous women w/out previous c-sect  12.2%**
 Table 3. Time from retracted cervix to vaginal birth and risk of any
maternal complication during the early postpartum period stratified by
mode of delivery
Discussion
Findings
• Risks of maternal early postpartum complications,
including infectious disease and urinary retention, ↑ with
duration of second stage of labour
• Risks were generally lowest if the second stage was <1
hour and highest if second stage was ≥3 hours
• Rates of maternal postpartum complications:
▫ Highest in parous women w/ previous c-sect
▫ Followed by primiparous women
▫ Lowest in parous women w/out previous c-sect
Findings
Causes for both urinary tract infection and urinary
retention:
•Frequent bladder catheterization
•Frequent vaginal examinations
•Instrumental delivery

Close supervision of the urinary bladder is

important during the second stage of labour
Strengths and limitations

Strengths:
•Population‐based design, complete access
to structured medical record data on the
mother, pregnancy, delivery and maternity
care*
•The guidelines in this study in line w/ US
and UK guidelines  findings could be
generalized to other developed country
Strengths and limitations

Limitations:
Follow up from delivery was restricted to the
hospitalisation period  complications after
discharge is unknown
Conclusion
Prolonged second stage of labour, >2 hours,
is associated with maternal infectious disease
and urinary retention in maternity care

Future research should study long‐term

consequences in women with urinary
retention during labour

Special attention has to be given to parous

women with previous caesarean section.
Thankyou