To define obstetrical risk factors for arrest of descent during the second stage of labor and to determine perinatal outcome.
STUDY DESIGN: All singleton, vertex, term deliveries with an unscarred uterus, between the years 1988 and 1999 were included. Univariable and multivariable analysis were performed to investigate independent risk factors associated with arrest of descent during the second stage of labor and the perinatal outcome.
RESULTS: The study included 93266 deliveries, of these 1545 (1.7%) were complicated with arrest of descent during the second stage of labor. Using a multivariable analysis, the following obstetric risk factors were found to be significantly associated with arrest of descent: nulliparity (OR=7.8, 95% CI=6.9-8.7; P<0.001),
birth weight >4 kg (OR=2.3, 95% CI=1.9-2.8; P<0.001),
epidural analgesia (OR=1.8, 95% CI=1.6-2.0; P<0.001),
hydramnios (OR=1.6, 95% CI=1.3-2.0; P<0.001), hypertensive disorders (OR=1.5, 95% CI=1.3-1.8; P<0.001),
gestational diabetes A1 and A2 (OR=1.5, 95% CI=1.2-1.8; P<0.001), male gender (OR=1.4, 95% CI=1.2-1.5; P<0.001), premature
rupture of membranes (PROM, OR=1.3, 95% CI=1.04-1.6; P=0.021), and
induction of labor (OR=1.2, 95% CI=1.02-1.4; P=0.030). Deliveries complicated by arrest of descent resulted in
cesarean section in 20.6%, vacuum extraction in 74.0%, and
forceps delivery in 5.4%. Newborns delivered after arrest of descent during the second stage of labor had significantly higher rates of low Apgar scores (<7) at 1 and 5 min, as compared to the controls (12.7 vs. 2.1%, P<0.001; and 0.9 vs. 0.2%, P<0.001, respectively). Nevertheless, no significant differences were noted between the groups regarding perinatal mortality (0.38 vs. 0.44%; P=0.759).
CONCLUSIONS: