Association between duration of second stage of labour and early maternal and neonatal outcomes of parturients at Kenyatta National Hospital in 2018 - a prospective descriptive cohort study

Abstract

Background: Time frames for second stage of labour to avert maternal and neonatal morbidity and mortality were introduced in the mid-1800s by expert opinion and case series publications. Findings were published where no stillbirths occurred when assisted delivery was employed to shorten second stage of labour. A 2-hour rule was established based on these findings.. Studies on association of duration of second stage of labour and neonatal outcomes have shown mixed results. Some studies have found an increase in poor neonatal outcomes including poor APGAR scores, admission to new born unit and neonatal intensive care unit, trauma and still birth with increase in duration of second stage while some studies have found no difference in outcomes in relation to duration of 2nd stage of labour. Objectives: The objective was to evaluate the median duration of second stage of labour and evaluate the association between the duration of second stage of labour and early maternal(mode of delivery, perineal tears, postpartum haemorrhage and puerperal sepsis) and neonatal outcomes(APGAR, admission to newborn unit and neonatal sepsis.) among mothers receiving intrapartum care at Kenyatta National hospital. Methodology: Using a prospective descriptive cohort study design, 232 mothers admitted in active phase of labour with low risk pregnancy that vaginal delivery was anticipated were recruited at Kenyatta National Hospital (KNH) between May 2018 and October 2018. KNH is situated in Nairobi county, the national referral and the teaching hospital for the University of Nairobi, Faculty of Medicine. The maternity wing conducts approximately 10,000 deliveries per year.It provides comprehensive obstetric care and specialized services. This facility is thus suited to carry out this research. The data was collected between May and October 2018. Study participants were mothers whose labour was monitored at the facility Standard (KNH) protocols for management of second stage of labour were used to record time at full dilatation, time of delivery of the baby and the maternal and neonatal outcomes of interest Results: Mean duration of second stage of labour was 52 mins.2nd stage more than 60mins was 16 times likely to undergo C/S and 6 times likely to develop puerperal sepsis compared to those 60 minutes and less. Neonates whose mothers spent more than 60 minutes in 2nd stage were 3 times likely to be admitted to the NBU and 6 times likely to develop neonatal sepsis compared to those whose mothers lasted less than 60 minutes. Conclusion: Median duration of 2nd stage at the KNH is 52 min.Duration of 2nd stage of labour of >60 min is associated with higher CS rates, puerperal sepsis among mothers, admission to NBU and neonatal sepsis . Recommendation: 2nd stage of labour lasting longer than 60 min calls for re-evaluation of the mother. Larger multicentre studies to establish cause effect for the non-significant parameters.