The management of the second stage of labour in women with cardiac: A mixed methods study

Abstract

Objective: To examine the duration of the passive and active parts of the second stage (SS) of labour in women with cardiac disease (CD) and to assess the adherence to antenatal care plans regarding timing of assisted delivery. Cardiac parameters were measured in a subset of women to investigate any differences between the passive and active SS of labour.

Study design: Cohort study of 73 women with CD, classified into mWHO Class Groups I-IV. Women were matched with an equal number of women controlling for gestational age, maternal age (+/- five years), parity, use of regional anaesthesia, and spontaneous versus assisted delivery. 12 of the 73 women with cardiac disease had cardiac parameters and oxygen saturations measured in the active and passive SS of labours.

Results: Length of passive SS was longer and the active component of the SS was significantly shorter in women with CD, because of a policy of elective assisted delivery. However, thirty four percent pushed for longer than was recommended. No adverse cardiac events were reported. Analysis of Holters showed no evidence of maternal arrhythmia in the active SS. Maternal heart rate increased at a modest but significant rate in the active SS.

Conclusion: Compliance with antenatal recommendations was poor; prolonged pushing was not associated with an increase in cardiac events. A restrictive policy for the duration of the active SS of labour in women with CD is currently based entirely on expert opinion and more prospective studies are needed justify this policy.

Ethics approval: West London Regional Ethics Committee REC reference: 13/LO/0042.

Keywords: Cardiac disease; Management; Second stage.