Effects Of Duration Of The Second Stage Of Labor On Maternal And Infant Outcomes In Primiparas With Gestational Diabetes Mellitus

OBJECTIVE:To investigate the effect of the length of the second stage of labor on maternal and infant outcomes in primiparous women with gestational diabetes mellitus(GDM).METHODS:One hundred and thirty-nine nulliparous women with gestational diabetes mellitus in cephalic presentation,singleton,and gestational age > 37 weeks who were admitted to the obstetrics department of Changde First People’s Hospital for vaginal trial of labor from January 2019 to April 2021 were selected,and all of them were delivered with epidural analgesia,and the basic data related to mothers,delivery information,and neonatal related data were collected.The length of the second stage of labor(88 cases in group A with t ≤ 3 hours,39 cases in group B with 3 hours < t < 4hours,and 12 cases in group C with t ≥ 4 hours)was grouped to observe the effect of the length of the second stage of labor on maternal and infant outcomes.Results: The differences in the rates of spontaneous vaginal delivery,vaginal surgical assisted delivery,episiotomy,and postpartum hemorrhage among the three groups were statistically significant(P<0.05),and the longer the second stage of labor,the lower the rate of spontaneous vaginal delivery,the higher the rate of vaginal surgical assisted delivery,the higher the rate of episiotomy,and the higher the rate of postpartum hemorrhage.The difference between group A and group B and group B and group C was statistically significant(P’<0.0167),the difference between group A and group B and group A and group C was statistically significant(P’<0.0167),and the difference between group A and group C was statistically significant(P’<0.0167)in the rate of postpartum hemorrhage.The differences were statistically significant(P<0.05).The differences in birth weight,length,neonatal umbilical artery blood gas analysis(lactic acid,potential of hydrogen,partial pressure of oxygen,partial pressure of carbon dioxide,bicarbonate,and alkaline residual),1-minute Apgar score <7,5-minute Apgar score <7,neonatal immediate birth glucose values,neonatal bilirubin values on the first day of life,and transfer to the neonatal unit were not statistically significant(P>0.05)when comparing the three groups.Conclusions:(1)The rate of perineal incision,postpartum hemorrhage,and vaginal surgical assisted delivery increased as the duration of the second stage of labor increased in primigravida with epidural analgesia;the rate of perineal incision and postpartum hemorrhage increased significantly when the duration of the second stage of labor was >3h;the rate of vaginal surgical assisted delivery increased significantly when the duration of the second stage of labor was ≥4h,and the rate of spontaneous vaginal delivery decreased significantly.(2)Short-term neonatal complications did not increase with prolonged second stage of labor in primiparous women with gestational diabetes mellitus under epidural analgesia.