Duration of the active first stage of labour and severe perineal lacerations and maternal postpartum complications: a population-based cohort study

Objective: The impact of first stage labour duration on maternal outcomes is sparsely investigated. We aimed to study the association between a longer active first stage and maternal complications in the early postpartum period.Design: A population-based cohort study.Setting: Regions of Stockholm and Gotland, Sweden, 2008-2020.Population: A cohort of 159 459 term, singleton, vertex pregnancies, stratified by parity groups.Methods: The exposure was active first stage duration, categorised in percentiles. Poisson regression analysis was performed to estimate the adjusted relative risk (aRR) and the 95% confidence interval (95% CI). To investigate the effect of second stage duration on the outcome, mediation analysis was performed.Main outcome measures: Severe perineal lacerations (third or fourth degree), postpartum infection, urinary retention and haematoma in the birth canal or ruptured sutures.Results: The risks of severe perineal laceration, postpartum infection and urinary retention increased with a longer active first stage, both overall and stratified by parity group. The aRR increased with a longer active first stage, using duration of <50th percentile as the reference. In the >= 90th percentile category, the aRR for postpartum infection was 1.64 (95% CI 1.46-1.84) in primiparous women, 2.43 (95% CI 1.98-2.98) in parous women with no previous caesarean delivery (CD) and 2.33 (95% CI 1.65-3.28) in parous women with a previous CD. The proportion mediated by second stage duration was 33.4% to 36.9% for the different outcomes in primiparous women. The risk of haematoma or ruptured sutures did not increased with a longer active first stage.Conclusions: Increasing active first stage duration is associated with maternal complications in the early postpartum period.

Automated summary

This study found that increasing duration of the active first stage of labor is associated with maternal complications in the early postpartum period. The risks of severe perineal lacerations, postpartum infection, and urinary retention increased with longer active first stage duration, while the risk of hematoma or ruptured sutures did not seem to be affected.