{
    "abstract": "To evaluate the effects of extending the second stage of labor in women attempting a trial of labor after a cesarean section (TOLAC).\nA retrospective cohort study comparing maternal and neonatal outcomes following TOLAC over two periods: period I whose prolonged second stage was considered 2\u2009h, and period II whose prolonged second stage was considered 3\u2009h. The primary outcome was repeat cesarean delivery (CD) rate.\nIncidence of repeat CD was significantly lower in period II (18.1% vs 29.7%, P\u2009<\u20090.001). Incidence of uterine rupture was significantly higher in period II (P\u2009<\u20090.001). Instrumental delivery rates were significantly higher in period II (26.2% vs 15.6%, odds ratio [OR] 1.67, 95% CI 1.21-3.56, P\u2009<\u20090.001). Rates of third- and fourth-degree perineal lacerations, chorioamnionitis, and length of hospital stay were similar between groups. Incidence of fetal acidemia was significantly higher in period II (1.5% vs 0.7%, OR 2.14, 95% CI 1.32-5.63, P\u2009<\u20090.001), and incidence of neonatal intensive care unit (NICU) admission was significantly higher (2.5% vs 1.6%, P\u2009=\u20090.004).\nExtension of the second stage of labor is associated with a decrease in repeat CD rate with a concomitant increase in instrumental delivery rates, uterine rupture, fetal acidemia, and NICU admissions. These findings may warrant further consideration of allowing a prolonged second stage in patients attempting TOLAC.",
    "authors": [
        {
            "affiliation": "Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel.",
            "firstname": "Roy",
            "initials": "R",
            "lastname": "Lauterbach"
        },
        {
            "affiliation": "Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel.",
            "firstname": "Naphtali",
            "initials": "N",
            "lastname": "Justman"
        },
        {
            "affiliation": "Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel.\nRuth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.",
            "firstname": "Yuval",
            "initials": "Y",
            "lastname": "Ginsberg"
        },
        {
            "affiliation": "Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel.",
            "firstname": "Yoav",
            "initials": "Y",
            "lastname": "Siegler"
        },
        {
            "affiliation": "Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel.",
            "firstname": "Gal",
            "initials": "G",
            "lastname": "Bachar"
        },
        {
            "affiliation": "Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel.\nRuth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.",
            "firstname": "Dana",
            "initials": "D",
            "lastname": "Vitner"
        },
        {
            "affiliation": "Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel.",
            "firstname": "Chen",
            "initials": "C",
            "lastname": "Ben-David"
        },
        {
            "affiliation": "Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel.\nRuth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.",
            "firstname": "Yaniv",
            "initials": "Y",
            "lastname": "Zipori"
        },
        {
            "affiliation": "Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel.\nRuth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.",
            "firstname": "Ron",
            "initials": "R",
            "lastname": "Beloosesky"
        },
        {
            "affiliation": "Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel.\nRuth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.",
            "firstname": "Zeev",
            "initials": "Z",
            "lastname": "Weiner"
        },
        {
            "affiliation": "Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel.\nRuth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.",
            "firstname": "Nizar",
            "initials": "N",
            "lastname": "Khatib"
        }
    ],
    "conclusions": "Extension of the second stage of labor is associated with a decrease in repeat CD rate with a concomitant increase in instrumental delivery rates, uterine rupture, fetal acidemia, and NICU admissions. These findings may warrant further consideration of allowing a prolonged second stage in patients attempting TOLAC.",
    "copyrights": "\u00a9 2023 International Federation of Gynecology and Obstetrics.",
    "doi": "10.1002/ijgo.14855",
    "journal": "International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics",
    "keywords": [
        "cesarean delivery",
        "instrumental delivery",
        "neonatal outcomes",
        "postpartum hemorrhage",
        "second stage of labor",
        "trial of labor after cesarean",
        "vaginal birth after cesarean",
        "vaginal delivery"
    ],
    "methods": "A retrospective cohort study comparing maternal and neonatal outcomes following TOLAC over two periods: period I whose prolonged second stage was considered 2\u2009h, and period II whose prolonged second stage was considered 3\u2009h. The primary outcome was repeat cesarean delivery (CD) rate.",
    "publication_date": "2023-05-13",
    "pubmed_id": "37177788",
    "results": "Incidence of repeat CD was significantly lower in period II (18.1% vs 29.7%, P\u2009<\u20090.001). Incidence of uterine rupture was significantly higher in period II (P\u2009<\u20090.001). Instrumental delivery rates were significantly higher in period II (26.2% vs 15.6%, odds ratio [OR] 1.67, 95% CI 1.21-3.56, P\u2009<\u20090.001). Rates of third- and fourth-degree perineal lacerations, chorioamnionitis, and length of hospital stay were similar between groups. Incidence of fetal acidemia was significantly higher in period II (1.5% vs 0.7%, OR 2.14, 95% CI 1.32-5.63, P\u2009<\u20090.001), and incidence of neonatal intensive care unit (NICU) admission was significantly higher (2.5% vs 1.6%, P\u2009=\u20090.004).",
    "title": "The impact of extending the second stage of labor on repeat cesarean section and maternal and neonatal outcome.",
    "xml": "<Element 'PubmedArticle' at 0x7885059f38d0>"
}