Duration of the second stage of labour and risk of subsequent spontaneous preterm birth

Geffen Kleinstern, Roy Zigron, Shay Porat, Joshua I. Rosenbloom, Misgav Rottenstreich, Yishay Sompolinsky, Amihai Rottenstreich*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Objectives: To determine the risk of spontaneous preterm birth (sPTB) associated with the length of second stage of labour in the first term delivery. Design: Retrospective cohort study. Setting: University hospital. Population: Women with first two consecutive singleton births and the first birth at term. Those who did not reach the second stage of labour in the first delivery were excluded. Methods: Charts from 2007 to 2019 were reviewed. Main outcome measures: Rate of sPTB (<37 weeks of gestation) in the second delivery. Results: Of 13 958 women who met study inclusion criteria, 1464 (10.5%) parturients had a prolonged second stage (≥180 min) in their first term delivery. The rate of sPTB in the second delivery was similar in those with and without a prolonged second stage in first delivery (2.8% versus 2.8%; adjusted odds ratio [aOR] 1.35, 95% CI 0.96–1.90). After adjustment for mode of delivery, prolonged second stage was also not associated with subsequent sPTB in those who delivered by spontaneous and operative vaginal delivery. Those delivered by second-stage caesarean section in the first delivery had a higher risk of sPTB in the second delivery (25/526, 4.8%; aOR 2.66, 95% CI 1.71–4.12; p < 0.001), with a more pronounced risk in those with second-stage caesarean following a prolonged second stage of labour (15/259, 5.8%; aOR 3.40, 95% CI 1.94–5.94; p < 0.001). Conclusion: Second-stage duration in a first term vaginal delivery is not associated with subsequent sPTB. The risk of sPTB is increased following second-stage caesarean section, particularly if performed after a prolonged second stage. Tweetable abstract: Second-stage caesarean delivery, particularly after prolonged second stage, increases the risk of preterm birth.

Original languageAmerican English
Pages (from-to)1743-1749
Number of pages7
JournalBJOG: An International Journal of Obstetrics and Gynaecology
Issue number10
Early online date13 Jan 2022
StatePublished - Sep 2022

Bibliographical note

Publisher Copyright:
© 2022 John Wiley & Sons Ltd.


  • caesarean section
  • labour duration
  • mode of delivery
  • preterm birth
  • prolonged second stage
  • term delivery


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