How does the duration of active pushing in labor affect neonatal outcomes?
-
Branka M. Yli
,
Grete A. Birkeland Kro
Abstract
Aim: To assess the effect of time of active pushing (TAP) on neonatal outcome.
Materials and methods: The study population (n=36,432) was taken from a Swedish randomized control trial on intrapartum monitoring, a European Union fetal electrocardiogram trial, and from Mölndal Hospital. After validation of acid-base samples and TAP, 22,812 cases were accepted for analysis.
Results: The median active TAP was 36 min for P0 and 13 min for P≥1 (P<0.001). After adjustments for parity, epidural, labor induction, birth weight, and gender, pushing for 15–29 min (n=6589) relative to pushing for <15 min (n=7264) increased the OR of a cord artery pH of <7.00 to 3.20 (95% CI 1.7–6.0), and that of a base deficit in extracellular fluid of >12 mmol/L to 3.5 (95% CI 1.3–9.0). The group with a cord artery pH of <7.00 had a longer TAP than the group with pH≥7.00: median (5th–95th percentile), 38 (9–107) min vs. 23 (5–87) min, P<0.001. The probability of a spontaneous vaginal delivery decreased significantly with every subsequent increase of 30 min in TAP (P<0.05).
Conclusion: The risks of severe acidemia, metabolic acidosis, and deteriorated neonatal outcome gradually increased with the length of TAP (>15 min), while the probability of a spontaneous vaginal delivery decreased with the duration of pushing. We suggest active physiological evaluation of the labor progress together with continuous electronic fetal monitoring during pushing irrespective of guideline thresholds.
©2012 by Walter de Gruyter Berlin Boston
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- Review Article
- Cardiac morbidity in twin-twin transfusion syndrome?
- Original Articles – Obstetrics
- Risk factors for postpartum hypertension in women with twin pregnancies
- Serum levels of the adipokine chemerin in preeclampsia
- Expression changes of sex hormone binding globulin in GDM placental tissues
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- Racial disparities in maternal hemoglobin concentrations and pregnancy outcomes
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- Endocervical immune mediator production following successful rescue or ultrasound indicated cerclage placement
- Co-ordinate expression of Th1/Th2 phenotypes in maternal and fetal blood: evidence for a transplacental nexus
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- Quantification of the subcutaneous fat layer with MRI in fetuses of healthy mothers with no underlying metabolic disease vs. fetuses of diabetic and obese mothers
- Original Article – Newborn
- Immediate clinical outcomes in preterm neonates receiving antenatal magnesium for neuroprotection
- Developmental delay in hypoxia-induced HO-1 expression predisposes to gut injury
- Short communication
- Correlation of Cyr61 and CTGF in placentas from the late pre-eclamptic pregnancy
- Letters to the Editor
- Cross-species transfer of group B streptococcus via ingestion?
- WAPM-Newsletter
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- Congress Calender
- Congress Calendar
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