Active phase labor arrest: revisiting the 2-hour minimum

Rouse, Dwight J.; Owen, John; Savage, Karen; Hauth, John C.

doi:10.1016/s0029-7844(01)01516-2

Cited by 72 publications

(54 citation statements)

References 4 publications

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“…Some studies have even used 3 cm as the definition of entry into active phase. [64][65][66] According to the guidelines, the active phase begins at 6 cm. The difference is of critical importance, because it has a dramatic effect on whether dysfunctional labor can be diagnosed early in the active phase.…”

Section: Analytical Issuesmentioning

confidence: 99%

Perils of the new labor management guidelines

Cohen

Friedman

2015

American Journal of Obstetrics and Gynecology

151

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Section: Analytical Issuesmentioning

confidence: 99%

Perils of the new labor management guidelines

Cohen

Friedman

2015

American Journal of Obstetrics and Gynecology

151

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“…This information gives clinicians a more objective assessment of whether labor arrest has occurred. This table suggests that a 2-hour threshold 14 may be too short before 6 cm whereas a 4-hour limit 22 may be too long after 6 cm. Given that the speed of cervical dilation is not constant, a graduated threshold based on the level of cervical dilation may be a more appropriate approach to defining labor arrest than a "one-size-fits-all" method.…”

Section: Discussionmentioning

confidence: 99%

The Natural History of the Normal First Stage of Labor

Zhang

Troendle

Mikolajczyk

et al. 2011

Obstetric Anesthesia Digest

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OBJECTIVE:To examine labor patterns in a large population and to explore an alternative approach for diagnosing abnormal labor progression. METHODS:Data from the National Collaborative Perinatal Project were used. A total of 26,838 parturients were selected who had a singleton term gestation, spontaneous onset of labor, vertex presentation, and a normal perinatal outcome. A repeated-measures analysis was used to construct average labor curves by parity. An interval-censored regression was used to estimate duration of labor stratified by cervical dilation at admission and centimeter by centimeter. RESULTS:The median time needed to progress from one centimeter to the next became shorter as labor advanced (eg, from 1.2 hours at 3-4 cm to 0.4 hours at 7-8 cm in nulliparas). Nulliparous women had the longest and most gradual labor curve; multiparous women of different parities had very similar curves. Nulliparas may start the active phase after 5 cm of cervical dilation and may not necessarily have a clear active phase characterized by precipitous dilation. The deceleration phase in the late active phase of labor may be an artifact in many cases. CONCLUSION:The active phase of labor may not start until 5 cm of cervical dilation in multiparas and even later in nulliparas. A 2-hour threshold for diagnosing labor arrest may be too short before 6 cm of dilation, whereas a 4-hour limit may be too long after 6 cm. Given that cervical dilation accelerates as labor advances, a graduated approach based on levels of cervical dilation to diagnose labor protraction and arrest is proposed.

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“…Subsequent studies [16,17] have demonstrated that this '2-hour rule' is overly conservative, with 88% of parturients proceeding to vaginal delivery if one waits 4 hours for cervical change to recommence. The most recent ACOG Practice Bulletin [18] does not specify a time for the diagnosis of active-phase labor arrest.…”

Section: Discussionmentioning

confidence: 99%