HealthDay News — 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, MD, 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 2414 of 3184 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 (1200 and 1204 women, respectively, completed the trial). 

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The researchers found that the rate of spontaneous vaginal delivery was 85.9 and 86.5% 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 5 of the 9 prespecified secondary outcomes, there was no significant difference, including the composite outcome of neonatal morbidity (7.3 and 8.9%, respectively; between-group difference, −1.6%; 95% confidence interval, −3.8 to 0.5%) and perineal lacerations (45.9 and 46.4 percent, respectively; between-group difference, −0.4 percent; 95% confidence interval, −4.4 to 3.6%).

“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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