School of Medicine and Health Sciences Poster Presentations

Title

The Effect of IUPC Use on Prolonged Second Stage of Labor

Document Type

Poster

Abstract Category

Women/Child Health

Keywords

Prolonged labor, Intrauterine Pressure Catheter, Women's health

Publication Date

Spring 5-1-2019

Abstract

We performed a retrospective cohort study to evaluate whether the use of Intrauterine Pressure Catheters (IUPC) in prolonged second stage of labor in nulliparous women affects maternal and neonatal outcomes. The study included term, nulliparous women with singleton gestations, cephalic presentation, epidural anesthesia, in labor, who reached 10 centimeters of cervical dilation and had a prolonged second stage of labor. Prolonged second stage was defined as > 3 hours. Exclusion criteria were intrauterine fetal demise, planned cesarean delivery or suspected major fetal anomaly. The primary outcome was incidence of spontaneous vaginal delivery, and maternal and neonatal outcomes were compared as secondary outcomes. In total, 208 women were evaluated. 27 women had IUPC's present and 181 women had no IUPC. Demographics differed between groups by ethnicity, hypertensive disorders and body mass index. In the IUPC group, 55.6% of women (15/27) had an SVD in comparison to 67.4% of women without an IUPC (122/181) (aOR 0.60, 95% CI 0.27-1.37). Women with an IUPC also delivered via operative vaginal delivery with an incidence of 14.8% (4/27) in comparison to 16.0% (29/181) of women without an IUPC (aOR 0.91, 95% CI 0.29-2.83). Women with an IUPC had a higher incidence of chorioamnionitis (29.6%, 8/27) (aOR 6.51, 95% CI 2.33-18.17) in comparison to women without an IUPC (6.1%, 11/181). Women with an IUPC also had a higher rate of postpartum hemorrhage (44.4%, 12/27) (aOR 4.03, 95% CI 1.71-9.46) in comparison to women without an IUPC (16.6%, 30/181). Neonatal complication rates were not different between groups. Of the women in the IUPC group, the IUPC was placed at an earlier cervical dilation in women who delivered via spontaneous vaginal delivery compared to women who had an operative delivery (5.7cm vs 7.6cm, p = 0.03). There was no difference in length of IUPC time, cervical dilation at placement, oxytocin dose or length of time on oxytocin between women who had a spontaneous vaginal delivery versus women who were delivered operatively. In conclusion, in nulliparous term women with singleton gestations, prolonged second stage and epidural anesthesia, IUPC placement did not influence SVD rate. Nevertheless, earlier placement of an IUPC was associated with vaginal delivery. IUPC use was associated with a 551% increase in chorioamnionitis and a 303% increase in hemorrhage. Neonatal outcomes were not affected by IUPC use.

Open Access

1

Comments

Presented at Research Days 2019.

This document is currently not available here.

Share

COinS
 

The Effect of IUPC Use on Prolonged Second Stage of Labor

We performed a retrospective cohort study to evaluate whether the use of Intrauterine Pressure Catheters (IUPC) in prolonged second stage of labor in nulliparous women affects maternal and neonatal outcomes. The study included term, nulliparous women with singleton gestations, cephalic presentation, epidural anesthesia, in labor, who reached 10 centimeters of cervical dilation and had a prolonged second stage of labor. Prolonged second stage was defined as > 3 hours. Exclusion criteria were intrauterine fetal demise, planned cesarean delivery or suspected major fetal anomaly. The primary outcome was incidence of spontaneous vaginal delivery, and maternal and neonatal outcomes were compared as secondary outcomes. In total, 208 women were evaluated. 27 women had IUPC's present and 181 women had no IUPC. Demographics differed between groups by ethnicity, hypertensive disorders and body mass index. In the IUPC group, 55.6% of women (15/27) had an SVD in comparison to 67.4% of women without an IUPC (122/181) (aOR 0.60, 95% CI 0.27-1.37). Women with an IUPC also delivered via operative vaginal delivery with an incidence of 14.8% (4/27) in comparison to 16.0% (29/181) of women without an IUPC (aOR 0.91, 95% CI 0.29-2.83). Women with an IUPC had a higher incidence of chorioamnionitis (29.6%, 8/27) (aOR 6.51, 95% CI 2.33-18.17) in comparison to women without an IUPC (6.1%, 11/181). Women with an IUPC also had a higher rate of postpartum hemorrhage (44.4%, 12/27) (aOR 4.03, 95% CI 1.71-9.46) in comparison to women without an IUPC (16.6%, 30/181). Neonatal complication rates were not different between groups. Of the women in the IUPC group, the IUPC was placed at an earlier cervical dilation in women who delivered via spontaneous vaginal delivery compared to women who had an operative delivery (5.7cm vs 7.6cm, p = 0.03). There was no difference in length of IUPC time, cervical dilation at placement, oxytocin dose or length of time on oxytocin between women who had a spontaneous vaginal delivery versus women who were delivered operatively. In conclusion, in nulliparous term women with singleton gestations, prolonged second stage and epidural anesthesia, IUPC placement did not influence SVD rate. Nevertheless, earlier placement of an IUPC was associated with vaginal delivery. IUPC use was associated with a 551% increase in chorioamnionitis and a 303% increase in hemorrhage. Neonatal outcomes were not affected by IUPC use.