Maternal and Perinatal Outcomes: Study gives Closer Look at Prolonged Second Stage of Labour in Rural setting

Recent study aimed to analyze the incidence, management, and outcomes of prolonged second stage of labor in a rural hospital in Malawi. Prolonged second stage labor can lead to maternal and perinatal complications, and the options for management include oxytocin augmentation, instrumental vaginal birth, or second-stage cesarean section. The study assessed a dataset of 3,426 births over a two-year period in St Luke's Hospital in Malawi. About 9% of women experienced a prolonged second stage, with interventions including oxytocin augmentation (7.2%), vacuum extraction (10.1%), or cesarean section (20.8%). The majority of women (69.1%) had spontaneous vaginal births.

Challenges and Outcomes

The study revealed that a considerable proportion of women arrived at the hospital already in the second stage of labor, which posed challenges in monitoring and timely intervention. Despite this, outcomes for these women were generally good without significant differences in maternal and neonatal complications compared to women admitted in earlier stages of labor. Women who were admitted during the second stage had higher parity, older age, and fewer antenatal care consultations. However, they had lower rates of previous cesarean sections.

Documentation and Interventions

Among the women admitted in the second stage, only a small percentage had a documented prolonged second stage on the partograph. Women in this subgroup experienced higher rates of instrumental vaginal births, cesarean sections, and complications. The study emphasized the need to enhance the use of vacuum extraction as an alternative to second-stage cesarean sections, which have higher risks. Training on instrumental vaginal birth, like vacuum extraction, was identified as crucial for clinicians to improve the quality of care and reduce complications associated with prolonged labor.

Implications for Maternal Health

The implications of the study suggest that timely attention, proper monitoring of labor progress, and the availability of instrumental birth methods can help prevent prolonged labor and its adverse outcomes. Enhancing the use of vacuum extraction, alongside appropriate training, can lead to significant improvements in maternal and neonatal health outcomes. This study provides valuable insights into clinical practices in low-resource settings and highlights the importance of tailored interventions to address the challenges associated with prolonged second stage labor in rural areas of Malawi.

Key Points

- The study focused on analyzing the incidence, management, and outcomes of prolonged second stage of labor in a rural hospital in Malawi, where 9% of women experienced this condition. Interventions for prolonged second stage labor included oxytocin augmentation, vacuum extraction, or cesarean section, with the majority (69.1%) having spontaneous vaginal births.

- A notable challenge identified was that a significant number of women arrived at the hospital already in the second stage of labor, which hindered monitoring and timely intervention. However, women admitted during the second stage did not show significant differences in maternal and neonatal complications compared to those admitted earlier, despite having higher parity, older age, and fewer antenatal care consultations.

- Documented cases of prolonged second stage on the partograph among women admitted in the second stage were minimal. This subgroup experienced more instrumental vaginal births, cesarean sections, and complications, highlighting the importance of improving documentation and considering vacuum extraction as an alternative to cesarean sections in such cases.

- The study underscored the necessity of training healthcare providers in instrumental vaginal birth techniques like vacuum extraction to enhance the quality of care and decrease complications related to prolonged labor. This training can potentially reduce the risks associated with second-stage cesarean sections and improve maternal and neonatal health outcomes.

- Timely attention, proper monitoring of labor progression, and the availability of instrumental birth methods were suggested as key factors in preventing prolonged labor and its adverse effects. Enhancing the use of vacuum extraction, coupled with appropriate training, has the potential to significantly enhance maternal and neonatal health outcomes, especially in low-resource settings such as rural areas of Malawi.

- The study provides valuable insights into clinical practices in low-resource settings, emphasizing the importance of tailored interventions to tackle the challenges associated with prolonged second stage labor. By addressing issues related to management and interventions, healthcare systems can improve outcomes for women experiencing prolonged labor, thus benefiting maternal and neonatal health in such regions.

Reference –

Wouter Bakker et al. (2025). Incidence, Management And Outcomes Of Prolonged Second Stage Of Labour In A Rural Setting In Malawi: A Retrospective Cohort Study. *BMC Pregnancy And Childbirth*, 25. https://doi.org/10.1186/s12884-025-07392-8.