During Labor After Prior Cesarean Delivery, a Prolonged Second Stage Needs Close Monitoring

Many obstetric care providers encourage women with one or two prior cesarean deliveries to consider a trial of labor with their next pregnancy in the hopes of achieving a vaginal birth. However, rupture of the uterine scar represents a major complication of trial of labor after cesarean. To assess the association between duration of the second stage of labor (the interval from full cervical dilation to delivery) and risk for such uterine rupture, investigators analyzed registry data from 4579 women who reached full cervical dilation during a trial of labor after cesarean.

Stratified by second-stage duration, rates of successful vaginal birth were 97.3% (<1 hour), 91.5% (1 to <2h), 78.5% (2 to <3h), 62.3% (3 to <4h), and 45.6% (≥4h). Risk for…