Impact of extended second stage of labor on maternal and neonatal outcomes

Human childbirth is categorized into four primary stages. The initial stage commences with intense uterine contractions that progressively widen the cervix until it reaches full dilation. The second stage begins once the cervix is completely dilated and concludes with the birth of the infant. Following this, the third stage starts after the infant's delivery and ends with the expulsion of the placenta and its accompanying membranes. A fourth stage has been recognized, which pertains to the initial hours following the delivery of the placenta. The second stage of labor is frequently overlooked, which can elevate the risk of complications for both the mother and the newborn. Diagnosing and managing an extended second stage of labor presents a considerable challenge, even for seasoned obstetricians. This review examines the factors contributing to the diagnosis of, and the treatment options for a prolonged second stage of labor, as well as the obstetric complications that may arise. Upon diagnosis, the underlying issues are addressed, and tailored care is provided, including decisions regarding the timing and method of intervention. The primary aim of this review is to elucidate the maternal and neonatal outcomes linked to a prolonged second stage of labor. The study was carried out at Zliten Medical Center over three years, from March 2020 to March 2023, involving a total of 890 participants. The average age of the women was categorized into two groups: 18 to 28 years (33.25%) and 29 to 38 years (51.34%). A significant portion, approximately 44.71%, had a body mass index (BMI) ranging from 20 to 24.9 kg/m². The gestational ages of the pregnancies varied between 37 and 41 weeks. Instrumental deliveries accounted for 77.19% of the cases, while non-instrumental deliveries represented 22.81%. Epidural analgesia was utilized by 59.10% of the women, and oxytocin was administered during delivery in 57.86% of the instances. The distribution of epidural anesthesia duration among women with multiple births was as follows: 0-1 times (6.51%), 1-2 times (6.51%), 2-3 times (5.28%), 3-4 times (3.59%), and more than 5 times (3.25%). Among those who had not yet delivered, 2.35% experienced a postpartum period of less than 2 hours, while 1.46% had a postpartum duration exceeding 2 hours. Furthermore, 3.48% of women who had not given birth reported a labor duration of less than 2 hours, whereas 1.46% experienced labor lasting more than 2 hours. The study emphasizes the importance of closely monitoring the mother and fetus during labor and initiating active treatment early to safely reduce labor time and minimize adverse outcomes.