Timing of Pushing Does Not Impact Spontaneous Vaginal Delivery

TUESDAY, Oct. 9, 2018 — For nulliparous women receiving neuraxial analgesia, the timing of second-stage pushing does not impact the rate of spontaneous vaginal delivery, according to a study published in the Oct. 9 issue of the Journal of the American Medical Association.

Alison G. Cahill, M.D., from Washington University in St. Louis, and colleagues conducted a randomized clinical trial of nulliparous women at or beyond 37 weeks of gestation admitted for spontaneous or induced labor with neuraxial analgesia. Recruitment was terminated with 2,414 of 3,184 planned participants due to suggested futility for the primary outcome (spontaneous vaginal delivery) in interim analysis. Participants who reached complete cervical dilation were instructed to begin pushing immediately or wait 60 minutes (1,200 and 1,204 women, respectively, completed the trial).

The researchers found that the rate of spontaneous vaginal delivery was 85.9 and 86.5 percent in the immediate and delayed groups, respectively, with no significant difference (relative risk, 0.99; 95 percent confidence interval, 0.96 to 1.03). For five of the nine prespecified secondary outcomes, there was no significant difference, including the composite outcome of neonatal morbidity (7.3 and 8.9 percent, respectively; between-group difference, −1.6 percent; 95 percent confidence interval, −3.8 to 0.5 percent) and perineal lacerations (45.9 and 46.4 percent, respectively; between-group difference, −0.4 percent; 95 percent confidence interval, −4.4 to 3.6 percent).

“These findings may help inform decisions about the preferred timing of second stage pushing efforts, when considered with other maternal and neonatal outcomes,” the authors write.

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Posted: October 2018

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