Admissions in second stage of labor in two teaching hospitals: obstetric outcomes and determining factors.

Introduction: Unmonitored labor and the second stage of labor are generally considered to be associated with increased maternal and neonatal complications. Study of admissions in the second stage of labor is important to understand the situation.

Objective: assess determinant factors and compare obstetric outcome of women admitted in second stage of labor with women admitted in the active phase of first stage of labor.

Methodology: This is a case control study conducted between March and April 2002 in two teaching hospitals in Addis Ababa, Ethiopia.

Results: Of the total 755 deliveries 148 (20%) were admitted in the second stage of labor. Illiterates, housewives, students and house maids---are significantly likely to be admitted in second stage of labor, OR 3.0, 4.6, 5.7 and 9.3, respectively. Significant association was observed between admission in second stage of labor and unknown last menstrual period, OR 5.6, 2.02-2.67. Main reasons for coming late included problems related to referral, decision-making, transport, money and delay within hospitals in 64.2%, 29.2%, 25.5%, 19% and 11.7%, respectively. Significant association was observed in rates of uterine rupture/obstructed labor and prolonged rupture of membranes in cases, OR 10.7 and 2.2, respectively. Fifth minute apgar score of < or = 3 was significantly higher in newborns of mothers admitted in second stage, OR 2.46, 1.12, 5.42. Neonatal ICU admission and perinatal loss were higher in mothers admitted in second stage though not significant.

Conclusion: Education, occupational status, economic problems, place of residence and institutional problems are determinants for admission in second stage. Maternal and perinatal complications are common in the cases. Timely referral, anticipation and management of complications related with admission in second stage is recommended.