Association of the duration of active pushing with obstetric outcomes

William A. Grobman, Jennifer Bailit, Yinglei Lai, Uma M. Reddy, Ronald J. Wapner, Michael W. Varner, Steve N. Caritis, Mona Prasad, Alan T N Tita, George Saade, Yoram Sorokin, Dwight J. Rouse, Sean C. Blackwell, Jorge E. Tolosa

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

OBJECTIVE: To estimate the associations between the duration of active pushing during the second stage of labor and maternal and neonatal outcomes. METHODS: We performed an observational study in which data were obtained by trained abstractors from maternal and neonatal charts of deliveries at 25 hospitals over a 3-year period. In this secondary analysis, women with no prior cesarean delivery who had a term, singleton, cephalic gestation and reached complete dilation were analyzed. The duration of pushing, defined as the time from initiation of pushing to either vaginal delivery or the decision to proceed with a cesarean delivery, was determined. The primary maternal outcome was cesarean delivery and the primary neonatal outcome was a composite that included: mechanical ventilation, proven sepsis, brachial plexus palsy, clavicular fracture, skull fracture, other fracture, seizures, hypoxic-ischemic encephalopathy, or death. Nulliparous and parous women were analyzed separately in univariable and then multivariable analyses. RESULTS: A total of 53,285 women were analyzed. In both nulliparous and parous women, longer duration of pushing was associated with increased odds of both cesarean delivery and the neonatal adverse outcome composite. Nevertheless, even after 4 hours of pushing, approximately 78% of nulliparous women who continued with active pushing had a vaginal delivery and more than 97% did not have the composite adverse neonatal outcome. Similarly, after more than 2 hours of pushing, approximately 82% of parous women who continued active pushing delivered vaginally and more than 97% did not have the adverse neonatal outcome. CONCLUSION: A longer duration of pushing is associated with an increased relative risk, but small absolute difference in risk, of neonatal complications. Approximately 78% of nulliparous women delivered vaginally even after 4 hours of pushing.

Original languageEnglish (US)
Pages (from-to)667-673
Number of pages7
JournalObstetrics and Gynecology
Volume127
Issue number4
DOIs
StatePublished - Apr 1 2016
Externally publishedYes

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Obstetrics
Mothers
Second Labor Stage
Skull Fractures
Brain Hypoxia-Ischemia
Brachial Plexus
Artificial Respiration
Paralysis
Observational Studies
Dilatation
Sepsis
Seizures
Head
Pregnancy

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Grobman, W. A., Bailit, J., Lai, Y., Reddy, U. M., Wapner, R. J., Varner, M. W., ... Tolosa, J. E. (2016). Association of the duration of active pushing with obstetric outcomes. Obstetrics and Gynecology, 127(4), 667-673. https://doi.org/10.1097/AOG.0000000000001354

Association of the duration of active pushing with obstetric outcomes. / Grobman, William A.; Bailit, Jennifer; Lai, Yinglei; Reddy, Uma M.; Wapner, Ronald J.; Varner, Michael W.; Caritis, Steve N.; Prasad, Mona; Tita, Alan T N; Saade, George; Sorokin, Yoram; Rouse, Dwight J.; Blackwell, Sean C.; Tolosa, Jorge E.

In: Obstetrics and Gynecology, Vol. 127, No. 4, 01.04.2016, p. 667-673.

Research output: Contribution to journalArticle

Grobman, WA, Bailit, J, Lai, Y, Reddy, UM, Wapner, RJ, Varner, MW, Caritis, SN, Prasad, M, Tita, ATN, Saade, G, Sorokin, Y, Rouse, DJ, Blackwell, SC & Tolosa, JE 2016, 'Association of the duration of active pushing with obstetric outcomes', Obstetrics and Gynecology, vol. 127, no. 4, pp. 667-673. https://doi.org/10.1097/AOG.0000000000001354
Grobman WA, Bailit J, Lai Y, Reddy UM, Wapner RJ, Varner MW et al. Association of the duration of active pushing with obstetric outcomes. Obstetrics and Gynecology. 2016 Apr 1;127(4):667-673. https://doi.org/10.1097/AOG.0000000000001354
Grobman, William A. ; Bailit, Jennifer ; Lai, Yinglei ; Reddy, Uma M. ; Wapner, Ronald J. ; Varner, Michael W. ; Caritis, Steve N. ; Prasad, Mona ; Tita, Alan T N ; Saade, George ; Sorokin, Yoram ; Rouse, Dwight J. ; Blackwell, Sean C. ; Tolosa, Jorge E. / Association of the duration of active pushing with obstetric outcomes. In: Obstetrics and Gynecology. 2016 ; Vol. 127, No. 4. pp. 667-673.
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abstract = "OBJECTIVE: To estimate the associations between the duration of active pushing during the second stage of labor and maternal and neonatal outcomes. METHODS: We performed an observational study in which data were obtained by trained abstractors from maternal and neonatal charts of deliveries at 25 hospitals over a 3-year period. In this secondary analysis, women with no prior cesarean delivery who had a term, singleton, cephalic gestation and reached complete dilation were analyzed. The duration of pushing, defined as the time from initiation of pushing to either vaginal delivery or the decision to proceed with a cesarean delivery, was determined. The primary maternal outcome was cesarean delivery and the primary neonatal outcome was a composite that included: mechanical ventilation, proven sepsis, brachial plexus palsy, clavicular fracture, skull fracture, other fracture, seizures, hypoxic-ischemic encephalopathy, or death. Nulliparous and parous women were analyzed separately in univariable and then multivariable analyses. RESULTS: A total of 53,285 women were analyzed. In both nulliparous and parous women, longer duration of pushing was associated with increased odds of both cesarean delivery and the neonatal adverse outcome composite. Nevertheless, even after 4 hours of pushing, approximately 78{\%} of nulliparous women who continued with active pushing had a vaginal delivery and more than 97{\%} did not have the composite adverse neonatal outcome. Similarly, after more than 2 hours of pushing, approximately 82{\%} of parous women who continued active pushing delivered vaginally and more than 97{\%} did not have the adverse neonatal outcome. CONCLUSION: A longer duration of pushing is associated with an increased relative risk, but small absolute difference in risk, of neonatal complications. Approximately 78{\%} of nulliparous women delivered vaginally even after 4 hours of pushing.",
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AU - Grobman, William A.

AU - Bailit, Jennifer

AU - Lai, Yinglei

AU - Reddy, Uma M.

AU - Wapner, Ronald J.

AU - Varner, Michael W.

AU - Caritis, Steve N.

AU - Prasad, Mona

AU - Tita, Alan T N

AU - Saade, George

AU - Sorokin, Yoram

AU - Rouse, Dwight J.

AU - Blackwell, Sean C.

AU - Tolosa, Jorge E.

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N2 - OBJECTIVE: To estimate the associations between the duration of active pushing during the second stage of labor and maternal and neonatal outcomes. METHODS: We performed an observational study in which data were obtained by trained abstractors from maternal and neonatal charts of deliveries at 25 hospitals over a 3-year period. In this secondary analysis, women with no prior cesarean delivery who had a term, singleton, cephalic gestation and reached complete dilation were analyzed. The duration of pushing, defined as the time from initiation of pushing to either vaginal delivery or the decision to proceed with a cesarean delivery, was determined. The primary maternal outcome was cesarean delivery and the primary neonatal outcome was a composite that included: mechanical ventilation, proven sepsis, brachial plexus palsy, clavicular fracture, skull fracture, other fracture, seizures, hypoxic-ischemic encephalopathy, or death. Nulliparous and parous women were analyzed separately in univariable and then multivariable analyses. RESULTS: A total of 53,285 women were analyzed. In both nulliparous and parous women, longer duration of pushing was associated with increased odds of both cesarean delivery and the neonatal adverse outcome composite. Nevertheless, even after 4 hours of pushing, approximately 78% of nulliparous women who continued with active pushing had a vaginal delivery and more than 97% did not have the composite adverse neonatal outcome. Similarly, after more than 2 hours of pushing, approximately 82% of parous women who continued active pushing delivered vaginally and more than 97% did not have the adverse neonatal outcome. CONCLUSION: A longer duration of pushing is associated with an increased relative risk, but small absolute difference in risk, of neonatal complications. Approximately 78% of nulliparous women delivered vaginally even after 4 hours of pushing.

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