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Labor

Poster Session 3

(841) To Push or Not to Push: Passive Descent and the Second Stage

Wednesday, February 14, 2024
8:30 AM – 10:00 AM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective:

Guidelines vary widely regarding management of the second stage (SS), with recommendations focusing on duration of active pushing (DOAP) and passive descent (PD). We evaluated the impact of oxytocin on DOAP and mode of delivery. We aimed to evaluate if management in the SS should vary depending on first stage (FS) progress/oxytocin use.

Study Design:

This was a retrospective cohort study of 300 SS Robson Group 1 patients in an Irish tertiary referral centre. The study had three arms, 100 consecutive patients were recruited to each arm: oxytocin acceleration in the FS, oxytocin de novo in the SS, and no oxytocin. Patients were grouped according to PD or active pushing. DOAP and mode of delivery were recorded.

Results:

Operative intervention rates were higher, and DOAP was longer for those with PD, p=.00, with an increase of 16.8 ± 2.7 minutes (95% C.I. = 11.5 – 22.1). When analyzed in terms of oxytocin use, the findings remained significant only for those with oxytocin acceleration in the FS.

Those with PD had higher rates of malposition (OP/OT) (22.3%) than those immediately pushing (18.7%). This did not reach statistical significance (p=.46). Station was higher for those with PD (p= .00). Adjusting for these confounding factors, both oxytocin use in the FS (p=.04) and PD (p=.00) predicted the duration of AP, explaining for 14% of the variance in DOAP (r2 = .14).

Conclusion:

Our findings agree with previous studies demonstrating a longer duration of the second stage has a significant impact on the mode of delivery. Our findings are novel in their differentiation by oxytocin use. The impact of PD on mode of delivery only retains significance for those with oxytocin in the FS, suggesting that for this cohort, limiting the duration of the SS is more important. PD may therefore be less beneficial for those with a dystocic FS and should the position and station of the vertex be suitable, AP should be encouraged. This may also limit pelvic floor damage secondary to both a prolonged FS and SS.