INTRODUCTION
Labor is a continuous, multifaceted process divided into three
stages.1 The first stage refers to the time from the
beginning of labor until the cervix is fully
dilated.123 The second stage describes the time from
full cervical dilation to delivery of the baby.1456The time from the expulsion of the baby to the removal of the placenta
refers to the third stage.17
The first stage consists of two parts, latent and active. According to
current studies, the latent phase defines as 0 to 6 cm, and however, the
active phase means the duration between 6 cm and full cervical
dilation.138910
Based on formal Friedman’s study, the latent phase duration in
nulliparas must be shorter than 20 hours and in multiparas, faster than
14 hours after the onset of the latent phase.811 The
active phase (time from 6 to 10 cm) is more rapid than the latent phase
in both induced and spontaneous labors.1213 Active
phase protraction means cervical dilatation in women with ≥6 cm and
dilatation duration of less than about 1 to 2
cm/hour.10 Active phase arrest defines that in a
pregnant woman with a cervical dilatation of ≥6 cm and ruptured
membranes; no cervical changes for ≥4 hours despite adequate
contractions or ≥6 hours even if contractions are
inadequate.381014
The optimal duration for the second stage of labor is still
controversial. Based on current data, it suggested for a nulliparous
patient 3 hours and 2 hours for a multiparous woman. If regional
anesthesia is performed, we can wait for 1 hour
more.181415 Longer times may be defined as second
stage arrest.
The protraction or arrest in the first or second stage of labor is a
significant risk factor for the primary cesarean. Maternal obesity,
macrosomia, cephalopelvic disproportion, neuraxial anesthesia, occiput
posterior position, nulliparity, uterine abnormality, short stature
(less than 150 cm), maternal age, post-term pregnancy, and
hypocontractile uterine activity states are associated with prolongation
and arrest of birth.1617
In the first stage of labor, especially in the active phase, oxytocin
augmentation and amniotomy may be an option for labor
progression.18 But women with labor arrest in the
first stage should be managed by cesarean delivery.15When the second stage arrest diagnosed, the obstetrician should consider
the options including observation, operative vaginal delivery, and
cesarean delivery if the maternal and fetal conditions
permit.16
Prolonged delivery may cause some
maternal and fetal complications. In the literature, the studies show
that a longer duration of the active phase and second stage of labor may
be associated with risk of operative vaginal delivery, cesarean
delivery, perineal lacerations, postpartum hemorrhage, chorioamnionitis,
shoulder dystocia, increased risks for neonatal intensive care unit
requirement, Apgar score decrease, hypoxic-ischemic encephalopathy and
fetal mortality.151619202122232425
Fetal soft tissue composite is in relation with gestational diabetes,
macrosomia, the risk for cesarean delivery and neonatal
adiposity.2627282930
Shoulder dystocia is one of the serious obstetrical complications as it
can cause permanent plexus brachialis injury. It occurs in 0.2 percent
of births. Although there are several known risk factors, the clinicians
often can not predict the shoulder dystocia. Clinicians should consider
the risk factors for shoulder dystocia and should be prepared to address
this complication in all deliveries.31 Shoulder
dystocia is a subjective clinical diagnosis, but there are some studies
as more objective definition criteria in the literature.3233
We have mentioned above the risk factors in prolonging labor. In this
study, we will examine the relationship between fetal adipose tissue
thickness without these risk factors but associated with them,
prolongation of delivery and complications caused by this. In this
context, it may be the first study in the literature regarding the
relationship between fetal adipose tissue thickness, prolonged delivery,
shoulder dystocia, and cesarean delivery.