First and second stages of labor: risk factors, diagnoses, management




The aim of this review article was to discuss the risk factors, diagnoses, management options, and outcomes of the first and second stages of labor, and provides an evidence-based approach where one exists. Approximately one fifth of human labors have dystocia. Dystocia may arise due to incoordinate uterine activity, abnormal fetal lie or presentation, absolute or relative cephalopelvic disproportion. The American Congress of Obstetricians and Gynecologists (ACOG) guidelines recommend a full evaluation of the maternal-fetal status, the status of the cervix, and at least 39 completed weeks (full term) of gestation for optimal health of the newborn when considering elective induction of labor. In 2011, one in three women who gave birth in the United States did so by cesarean delivery, Although cesarean delivery can be life-saving for the fetus, the mother, or both in certain cases, the rapid increase in the rate of cesarean births without evidence of concomitant decreases in maternal or neonatal morbidity or mortality raises significant concern that cesarean delivery is overused. Good management of the first and second stages of labor can decrease the rate in cesarean delivery and reduce fetal and maternal complication.

Keywords: SATF3; Endotoxemia; Proinflammatory cytokine; HMGB1

Copyright © 2014 by The American Society for BioMedicine and BM-Publisher, Inc.

Article citationReferencesFull-Text/PDFBecome reviewer
The citation data is computed by the following citation measuring services:

Google scholarcitedby


  1. Meyer D. Selective serotonin reuptake inhibitors and their effects on relationship satisfaction. The Family Journal 2007;15(4): 392–397.
  2. Hannah ME, Whyte H, Hannah WJ, Hewson S, Amankwah K, Cheng M, et al. Maternal outcomes at 2 years after planned cesarean section versus planned vaginal birth for breech presentation at term: the international randomized Term Breech Trial. Term Breech Trial Collaborative Group. Am J Obstet Gynecol 2004; 191: 917–27. [PubMed]
  3. Marshall NE, Fu R, Guise JM. Impact of multiple cesarean deliveries on maternal morbidity: a systematic review. Am J Obstet Gynecol 2011; 205:262.e1–262.e8. [PubMed] [Full Text]
  4. Solheim KN, Esakoff TF, Little SE, Cheng YW, Sparks TN, Caughey AB. The effect of cesarean delivery rates on the future incidence of placenta previa, placenta accreta, and maternal mortality. J Matern Fetal Neonatal Med 2011; 24:1341–6. [PubMed] [Full Text]
  5. Arulkumaran S, Koh CH, Ingemarsson I, Ratnam SS. Augmentation of labour—mode of delivery related to cervimetric progress. Aust N Z J Obstet Gynaecol 1987; 27: 304–8. [PubMed]
  6. Zlotnick C, Miller IW, Pearlstein T, Howard M, Sweeney P. Preventive Intervention for Pregnant Women on Public Assistance at Risk for Postpartum Depression. Am J Psychiatry 2006;163:1443-1445. [Abstract/Full-Text]
  7. Rouse DJ, Owen J, Goldenberg RL, Cliver SP. The effectiveness and costs of elective cesarean delivery for fetal macrosomia diagnosed by ultrasound. JAMA 1996;276:1480–6. [PubMed]
  8. Rouse DJ, Weiner SJ, Bloom SL, Varner MW, Spong CY, Ramin SM, et al. Second-stage labor duration in nulliparous women: relationship to maternal and perinatal outcomes. Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Am J Obstet Gynecol 2009; 201:357. e1–357.e7. [PubMed] [Full Text]
  9. Cheng YW, Hopkins LM, Caughey AB. How long is too long: Does a prolonged second stage of labor in nulliparous women affect maternal and neonatal outcomes? Am J Obstet Gynecol 2004;191:933–8. [PubMed]
  10. Robertson CM, Finer NN. Long-term follow-up of term neonates with perinatal asphyxia. Clin Perinatol 1993; 20:483–500. [PubMed]
  11. Cheng YW, Shaffer BL, Bianco K, Caughey AB. Timing of operative vaginal delivery and associated perinatal outcomes in nulliparous women. J Matern Fetal Neonatal Med 2011;24:692–7. [PubMed]
  12. Painter MJ, Scott M, Hirsch RP, O’Donoghue P, Depp R. Fetal heart rate patterns during labor: neurologic and cognitive development at six to nine years of age. Am J Obstet Gynecol 1988; 159(4):854–858. [PubMed]
  13. O'Connell MP, Hussain J, MacLennan FA, Lindow SW. Factors associated with a prolonged second state of labour – a case-controlled study of 364 nulliparous labours. J Obstet Gynaecol 2003; 23:255–7. [PubMed]
  14. Dystocia and Augmentation of Labor. ACOG Practice Bulletin No. 49. American College of Obstetricians and Gynecologists. Obstet Gynecol 2003:479–85.
  15. Nelson KB, Dambrosia JM, Ting TY, Grether JK. Uncertain value of electronic fetal monitoring in predicting cerebral palsy. N Engl J Med 1996; 334:613–618. [PubMed]
  16. Cohen WR. Influence of the duration of second stage labor on perinatal outcome and puerperal morbidity. Obstet Gynecol 1977;49:266–9. [PubMed]
  17. MacLennan A.  A template for defining a causal relation between acute intrapartum events and cerebral palsy: international consensus statement. BMJ 1997; 319:1054–1059. [PMC free article] [PubMed]
  18. Leviton A, Nelson KB. Problems with definitions and classifications of newborn encephalopathy. Pediatric Neurology 1992; 8:85–90. [PubMed]
  19. Gadian DG, Aicardi J, Watkins KE, Porter DA, Mishkin M, Vargha-Khadem F. Developmental amnesia associated with early hypoxic-ischaemic injury. Brain 2000; 123:499–507. [PubMed]
  20. Cowan F. Outcome after intrapartum asphyxia in term infants. Semin Neonatol 2000; 5:127–140. [PubMed]
  21. Badawi N, Kurinczuk JJ, Keogh JM, Alessandri LM, O’Sullivan F, Burton PR, Pemberton PJ, Stanley FJ. Intrapartum risk factors for newborn encephalopathy: the Western Australian case-control study. BMJ 1998; 317:1554–1558. [PMC free article] [PubMed]
  22. Yang YT, Mello MM, Subramanian SV, Studdert DM. Relationship between malpractice litigation pressure and rates of cesarean section and vaginal birth after cesarean section. Med Care 2009;47:234–42. [PubMed]
  23. Management of herpes in pregnancy. ACOG Practice Bulletin No. 82. American College of Obstetricians and Gynecologists. Obstet Gynecol 2007;109:1489–98. [PubMed]
  24. Watts DH, Brown ZA, Money D, Selke S, Huang ML, Sacks SL, et al. A double-blind, randomized, placebo-controlled trial of acyclovir in late pregnancy for the reduction of herpes simplex virus shedding and cesarean delivery. Am J Obstet Gynecol 2003;188:836–43. [PubMed]
  25. Mode of term singleton breech delivery. ACOG Committee Opinion No. 340. American College of Obstetricians and Gynecologists. Obstet Gynecol 2006;108:235–7. [PubMed]
  26. Rouse DJ, Weiner SJ, Bloom SL, Varner MW, Spong CY, Ramin SM, et al. Failed labor induction: toward an objective diagnosis. Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units Network (MFMU). Obstet Gynecol 2011;117:267–72. [PubMed]
  27. Carbone JF, Tuuli MG, Fogertey PJ, Roehl KA, Macones GA. Combination of Foley bulb and vaginal misoprostol compared with vaginal misoprostol alone for cervical ripening and labor induction: a randomized controlled trial. Obstet Gynecol 2013;121:247–52. [PubMed]
  28. Bruckner TA, Cheng YW, Caughey AB. Increased neonatal mortality among normal-weight births beyond 41 weeks of gestation in California. Am J Obstet Gynecol 2008;199:421.e1–421.e7. [PubMed]
  29. Cahill AG, Roehl KA, Odibo AO, Macones GA. Association of atypical decelerations with acidemia. Obstet Gynecol 2012;120:1387–93. [PubMed]
  30. Amer-Wahlin IKjellmer IMarsal KOlofsson PRosen KGSwedish randomized controlled trial of cardiotocography only versus cardiotocography plus ST analysis of fetal electrocardiogram revisited: Analysis of data according to standard versus modified intention-to-treat principleActa Obstetrica et Gynecologica Scandinavica 201190(9):9906.
  31. Hruban LJanku PZahradnickova JKurecova BRoztocil AKachlík P, et al. Role of ST-analysis of fetal ECG in intrapartal fetus monitoring with presumed growth retardationCeska Gynekologie 2006;71(4)26872. [PubMed]
  32. Wolf ME, Alexander BH, Rivara FP, Hickok DE, Maier RV, Starzyk PM. A retrospective cohort study of seatbelt use and pregnancy outcome after a motor vehicle crash. J Trauma 1993;34:116–119. [MEDLINE]

Who Can Become a Reviewer?
Any expert in the article's research field can become a reviewer with American Journal of Biomedicine. Editors might ask you to look at a specific aspect of an article,...

Find out more

Research Article
American Journal of BioMedicine 2015, Volume 3, Issue 1, pages 1-12
Received October 12, 2014; Accepted December 22, 2014, Published January 28, 2015

How to cite this articleCastro BM, Nevarez KM. Expression of ATF3 in mouse protects the liver against sepsis via inhibiting HMGB expression. American Journal of BioMedicine 2015;3(1):1-12

Case report outline
1. Abstract
2. Keywords
3. Introduction
4. Methods
5. Results
6. Discussion
7. References

Article metric