Prolonged second stage of labour is an important cause of maternal and perinatal morbidity and mortality. Vacuum extraction (VE) and second‐stage caesarean section (SSCS) are the most commonly performed obstetric interventions, but the procedure chosen varies widely globally.

Vacuum extraction or caesarean section in the second stage of labour: A systematic review

Pelvic floor dysfunction refers to any combination of incontinence, overactive bladder, pelvic organ prolapse, and sexual dysfunction. Pelvic floor dysfunction affects approximately 25% to 30% of women and is linked to parity and age. Some obstetrical risk factors have been highlighted, though the second stage of labor has not been as thoroughly investigated. Allowing a longer second stage has been suggested as a method of reducing the rates of cesarean delivery in nulliparous women, though it has also been linked to pelvic floor injuries.This study aimed to determine the effect of the length of the second stage of labor on self-reported pelvic floor dysfunction.This was a single-center prospective cohort study in a tertiary referral obstetrical unit. Nulliparous women attending routine antenatal clinics were recruited to complete the Australian Pelvic Floor Questionnaire during pregnancy and again 3 months after delivery. The primary outcome in this study was the effect of the length of the second stage of labor on total pelvic floor scores when analyzed using multiple regression. The models were adjusted for the mother's age, mother's body mass index, length of the second stage of labor, fetal birthweight, mode of delivery, and perineal trauma. The secondary outcomes included the comparison of maternal, obstetrical, and functional pelvic floor outcomes based on the mode of delivery and the length of the second stage of labor.Among the 295 women who were recruited, the length of the second stage of labor and body mass index were associated with self-reported bladder dysfunction on multiple regression, whereas maternal age was protective. Compared with those with 60 to 120 minutes or <60 minutes of second stage of labor, women with that longer than 120 minutes had higher rates of stress incontinence (85.7% [>120 minutes] vs 41.7% [60-120 minutes] or 52.5% [<60 minutes], P=.001), urinary urgency (89.3% [>120 minutes] vs 39.6% [60-120 minutes] or 53.8% [<60 minutes], P<.001), and fecal incontinence (10.7% [>120 minutes] vs 0% [60-120 minutes] or 1.2% [<60 minutes], P=.027). There were no differences in the rates of sexual activity or dyspareunia. Women delivering vaginally had higher rates of stress incontinence (57.6% vs 38.0%, P=.006) than those undergoing cesarean delivery, though there were no differences in other pelvic floor symptoms or pelvic floor scores.A prolonged second stage of labor is associated with more self-reported bladder dysfunction at 3 months postnatal in primiparous women. Women with a longer second stage of labor should be informed about the risk of short-term bladder dysfunction, though the prevalence of long-term sequelae is unknown. 

The effect of the length of the second stage of labor on pelvic floor dysfunction.

"Assisted vaginal birth using the Paily obstetric forceps vs Ventouse - A randomized clinical trial".

Maternal and Neonatal Morbidity After Attempted Operative Vaginal Delivery

To systematically review the worldwide second stage cesarean rate, in relation to the rates of pre-second stage cesarean delivery and assisted vaginal birth. PubMed, Medline Ovid, EBSCOhost, Embase, Scopus and Google Scholar were queried from inception to February 2023, with the following terms: ‘full dilatation’, ‘second stage’ and ‘cesarean’, with their word variations. We also included an additional cohort of 353,434 cases from our recent published study. We included only original studies that provided sufficient information on the number of pre-second stage cesarean delivery, second stage cesarean delivery, and vaginal delivery for calculation of different modes of delivery. Systemic reviews, meta-analyses or case reports were excluded. Study identification and data extraction were independently performed by two authors. Selected studies were categorized based on parity, study period and geographical regions for comparison. Twenty-five studies were included. Their overall rates of pre-second stage cesarean, second stage cesarean, and second stage cesarean to assisted vaginal birth ratio were respectively 18.01%, 2.46% and 0.17. Only five studies described singleton term cephalic presenting pregnancies of nulliparous women, and their second stage cesarean rate was significantly higher than those studies with cohorts of all parity group (4.50% vs 0.83%; P<0.05). The second stage cesarean rate also showed a secular increase across 2009 (0.70% vs 0.99%; P<0.05). It was also highest among African studies (5.14%) but lowest among studies from East and South Asia (0.91%). The distribution of second stage cesarean rates of individual studies and subgroups were shown with that of pre-second stage cesarean and assisted vaginal birth using the bubble chart. The overall worldwide pre-second stage cesarean rate was 18.01%, that of the second stage cesarean was 2.46%, and the second stage cesarean to assisted vaginal birth ratio was 0.17. The African studies had the highest second stage cesarean rate (5.14%) and second stage cesarean to assisted vaginal birth ratio (1.88), while the studies from East and South Asia were at the opposite (0.91% and 0.09 respectively). 

The Use of Bubble Charts in Analyzing the Global Second Stage Cesarean Rates: a Systematic Review

Comparison of perinatal outcomes for all modes of second stage delivery in obstetric theatres: a retrospective observational study

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Comparison of perinatal outcomes for all modes of second stage delivery in obstetric theatres: a retrospective observational study