Prolonged second stage in nulliparous with epidurals: a systematic review

Objective: Management of prolonged second stage of labor remains a clinical challenge. Nulliparous with epidurals are the most likely women to have a prolonged second stage and can be difficult to manage. The aim of this study was to evaluate the maternal and fetal morbidities associated with prolonged second stage of labor in nulliparous women with epidurals. Methods: A systematic review of the literature was performed using PubMed, Ovid and Scopus searches for case series evaluating the morbidities of prolonged second stage of labor. Search terms used were "prolonged'', "second stage'', and "labor''. Prolonged second stage was defined as three hours or more. Retrospective case series of prolonged second stage in nulliparous women with epidurals were identified. The primary outcome was the incidence of cesarean delivery. Results: Two retrospective series with 5350 nulliparous women with prolonged second stage were identified. 76.3% (4 081/5 350) had an epidural. Of all nulliparous women with an epidural, 11.5% (4 081/35 469) had prolonged second stage. Cesarean Delivery occurred in 19.8% of these cases (782/4 081), while 80.2% had a vaginal delivery. Conclusions: Over three quarters of nulliparous women with epidural diagnosed with a prolonged second stage deliver vaginally.