August 6, 2025Archives of Gynecology and ObstetricsOpen Access

Second stage of labor beyond 4 h in nulliparous patients with epidural analgesia: implications and outcomes—a retrospective cohort

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Authors

GCGal CohenTel Aviv University MKMichal KovoHebrew University of Jerusalem HSHila Shalev‐RamTel Aviv University

Discussion

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Implication

Retrospective cohort analysis shows increased risks of neonatal trauma and failed vacuum extraction beyond 4 hours in nulliparous patients, indicating significant implications for obstetric management.

Key Points

Most nulliparous patients achieve vaginal delivery even after exceeding 4 hours during the second stage of labor.
Patients in the > 4 h group demonstrated significantly lower vaginal delivery rates at 80.4% compared to 93% in the 3–4 h group.
Higher occurrences of neonatal trauma, such as shoulder dystocia and subgaleal hematoma, were recorded in the > 4 h group at rates of 2.7% and 9.0%, respectively.
Adjusted analysis revealed that durations over 4 hours elevate the risks for neonatal trauma and failed vacuum extractions, highlighting the need for careful monitoring.

Cite This Study

Cohen et al. (2025) studied this question.

synapsesocial.com/papers/689521e49f4f1c896c427fde https://doi.org/10.1007/s00404-025-08141-0

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