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Recording available 2/16-5/2
Recording available 2/16-5/2
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Poster Session 2

Category: Labor

Poster Session 2

(665) Prolonged second stage in the presence of meconium-stained amniotic fluid: Is it worth the wait?

Wednesday, February 11, 2026
3:30 PM - 5:00 PM  

    Submitting Author and Presenting Author(s)

  • Shani Abramov, MD

    OBGYN resident
    Lis Hospital for Women’s Health, Tel Aviv Sourasky Medical Center
    Tel-Aviv, Tel Aviv, Israel

    • Coauthor(s)

  • Omri Dominsky, MD, MPH (he/him/his)

    OB\GYN resident
    Lis Hospital for Women’s Health, Tel Aviv Sourasky Medical Center
    Lis Hospital for Women’s Health, Tel Aviv Sourasky Medical Center, HaMerkaz, Israel

  • Roza Shperling-Berkovitz, MD, MPH

    Lis Hospital for Women’s Health, Tel Aviv Sourasky Medical Center
    ichilov, HaMerkaz, Israel

  • AL

    Anat Lavie, MD

    Lis Hospital for Women’s Health, Tel Aviv Sourasky Medical Center
    ISRAEL, Tel Aviv, Israel

  • YY

    Yariv Yogev, MD

    Lis Hospital for Women’s Health, Tel Aviv Sourasky Medical Center Gray Faculty of Medicine, Tel Aviv University, Israel
    Lis Hospital for Women’s Health, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

  • Liran Hiersch, MD

    MFM specialist
    Lis Hospital for Women’s Health, Tel Aviv Sourasky Medical Center Gray Faculty of Medicine, Tel Aviv University, Israel
    ISRAEL, Tel Aviv, Israel

  • Uri Amikam, MD, MHA (he/him/his)

    MFM Specialist
    Lis Hospital for Women’s Health, Tel Aviv Sourasky Medical Center
    Tel Aviv, Tel Aviv, Israel

Objective:

To determine whether meconium-stained amniotic fluid (MSAF) during prolonged second stage (PSS) of labor is associated with increased perinatal morbidity.

Study Design:

A retrospective cohort study including term singleton vertex live births with PSS at a single center (2020–2025). PSS was defined as >2 or >3 hours in nulliparas and >1 or >2 hours in multiparas, with or without epidural analgesia, respectively. Deliveries with MSAF were compared to those with clear fluid. Multivariable logistic regression adjusted for confounders. A sub-analysis was conducted for nulliparous women. Two composite outcomes were evaluated: a maternal composite including intrapartum fever, postpartum hemorrhage (PPH), obstetric anal sphincter injury (OASI), blood transfusion, or shoulder dystocia; and a neonatal composite including 5-minute Apgar < 7, umbilical cord pH < 7.1, or NICU admission.

Results:


  1. Overall, out of 54,525 deliveries, 3,665 (6.7%) met PSS criteria; among these, 660 (18%) had MSAF and 3,005 (82%) had clear amniotic fluid.

  2. The MSAF group had higher rates of vacuum extraction (55.6% vs. 48.5%, P=0.001), OASI (3.0% vs. 0.9%, P=0.001), PPH (11.2% vs. 8.1%, P=0.011), and blood transfusion (5.3% vs. 3.4%, P=0.022).

  3. Utilizing multivariable logistic regression adjusting for maternal age >35 years, pre-gestational BMI, induction of labor, prelabor rupture of membranes, epidural analgesia, gestational age, and birthweight, composite maternal morbidity was significantly higher in the MSAF group (20.0% vs. 15.6%, aOR 1.3, CI(1.036-1.627), P=0.006), with comparable composite neonatal morbidity (5.8% vs. 4.7%, aOR 1.14, CI(0.78-1.69), P =0.231).

  4. The sub-analysis including only nulliparas (n=2,749) demonstrated similar results (Figure).



Conclusion:
In the setting of a prolonged second stage, the presence of meconium-stained amniotic fluid is associated with increased maternal morbidity, with comparable neonatal morbidity.