Effect of prolonged total stage of labor on maternal perinatal outcomes after application of new partogram

Objective To study the perinatal outcomes of pregnant women when their total stage of labor over 24 hours after the application of new partogram. Methods A retrospective case-control study was conducted on 3 991 pregnant women who received routine prenatal care and intrapartum management according to new partogram and delivered at full-term with alive babies at Beijing Obstetrics and Gynecology Hospital from October 1, 2014 to January 31, 2015. Among these 3 991 women, 85 delivered after 24-hours' labor and all were nulliparas, while five of the 85 converted to cesarean section (CS group) and 80 delivered vaginally (study group). Another 160 primigravidas were randomly selected from those vaginal deliveries with the total stage of labor less than 24 h as control group. The general conditions, maternal and fetal perinatal outcomes were compared between the study and control group and between the study and CS group. The duration of labor was compared among different groups of women in the study group. Independent sample t-test, Rank-sum test, Chi-square test or Fisher's exact test were applied for statistics. Results The durations of first stage, second stage, third stage and total stage of labor were all longer in the study group than in the control [25.7(23.8-26.8) vs 10.4(5.9-13.9) h, 1.4(0.6-1.8) vs 0.8(0.4-1.0) h, 0.14(0.08-0.17) vs 0.11(0.07-0.13) h, 27.2(24.9-26.8) vs 10.4(5.9-14.0) h, Z=12.525, 4.359, 3.528 and 12.588, all P 0.05) except for newborns' birth weight [(3 542±388) vs (3 431±368) g, t=2.162, P=0.032]. However, the incidences of postpartum hemorrhage, intrapartum fever and neonatal admission to NICU were comparable between the study (n=20) and CS group (both P>0.05). Within the study group, the durations of second stage of labor in women with postpartum hemorrhage, assisted vaginal delivery and episiotomy were significantly longer than those without [1.8(0.9-3.1) vs 1.2(0.5-1.5) h, 2.0(0.8-3.4) vs 1.2(0.5-1.6) h, 1.7(0.6-2.6) vs 1.1(0.5-1.5) h, Z=2.168, 2.756 and 1.891, all P<0.05]. Conclusions After the application of new partogram, vaginal delivery remains possible for pregnant women whose total stage of labor over 24 hours without increase of neonatal morbidity. However, the incidences of postpartum hemorrhage, episiotomy and assisted vaginal delivery may rise up. Key words: Labor, obstetric; Patient care; Pregnancy outcome