Women delivered >120 minutes after presentation
Of the 83 women delivered >120 minutes after presentation,
4 experienced a sentinel event (1 cord prolapse and 3 uterine ruptures).
Excluding the 4 women with a sentinel event, the majority of women
(84%, n=66/79) had moderate variability, accelerations, or both on
presentation (in the first 30 minutes of the tracing) including moderate
variability, accelerations, or both. Of the 66 women with moderate
variability and/or accelerations on presentation, 40% (27/66) retained
these features (moderate variability, accelerations, or both) in the
final 30 minutes before delivery (Figure 2, Table 4 ). The
majority of the 27 women with moderate variability and/or accelerations,
prior to delivery underwent cesarean delivery (n=16). Of the 39 women
without moderate variability or accelerations prior to delivery the
majority were by operative (10%, n=4) or non-operative vaginal delivery
(54%, n=21). Mode of delivery did not differ significantly based on the
whether the FHR tracing demonstrated moderate variability and/or
accelerations prior to delivery (p=0.17).
The labor courses and clinical management of the 27 women with moderate
variability, accelerations, or both on presentation and prior to
delivery were heterogenous (Figure 3 ). Among this group there
were 2 cases of intrauterine growth restriction and 2 cases of clinical
chorioamnionitis. Seven women underwent a pre-labor cesarean delivery
and 1 woman underwent a cesarean delivery in the first stage of labor.
The remaining 8 women underwent cesarean delivery during second stages
that ranged from 62 to 428 minutes; 3 of these cesareans occurred after
failed operative vaginal delivery attempts. Of the 11 women undergoing
vaginal delivery 6 had a second stage ≤1 hour, 3 had a second stage 1 to
≤3 hours, and 2 had a second stage >3 hours both of which
required operative vaginal delivery. Overall, 8 of the 27 women had a
second stage of ≥3 hours and 7 had labor courses ≥18 hours.