Contemporary Patterns of Spontaneous Labor With Normal Neonatal Outcomes

Abstract

Objective-To use contemporary labor data to examine the labor patterns in a large, modern obstetric population in the United States.Methods-Data were from the Consortium on Safe Labor, a multicenter retrospective study that abstracted detailed labor and delivery information from electronic medical records in 19 hospitals across the United States. A total of 62,415 parturients were selected who had a singleton term gestation, spontaneous onset of labor, vertex presentation, vaginal delivery, 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-Labor may take over 6 hours to progress from 4 to 5 cm and over 3 hours to progress from 5 to 6 cm of dilation. Nulliparas and multiparas appeared to progress at a similar pace before 6 cm. However, after 6 cm labor accelerated much faster in multiparas than in nulliparas. The 95 th percentile of the 2 nd stage of labor in nulliparas with and without epidural analgesia was 3.6 and 2.8 hours, respectively. A partogram for nulliparas is proposed.Conclusion-In a large, contemporary population, the rate of cervical dilation accelerated after 6 cm and progress from 4 to 6 cm was far slower than previously described. Allowing labor to continue for a longer period before 6 cm of cervical dilation may reduce the rate of intrapartum and subsequent repeat cesarean deliveries in the United States.

Placenta previa: an outcome-based cohort study in a contemporary obstetric population

“…We did not track the number of cesareans in either group, but our rate was closer to those with two previous cesarean deliveries, as reported in a prior study. When placenta accreta is diagnosed antenatally and confirmed surgically, typically, a hysterectomy is performed, with the placenta left in situ [13]. The significantly increased rate of placenta accreta in our previa group most likely accounts for the significant increase in cesarean hysterectomy between the two groups; 2.7 % in the placenta previa group, compared to 0.2 % in the control group, OR 8.6 (2.7-26.9).…”

“…Placenta accreta confers greater blood losses, blood transfusions, and possibly cesarean hysterectomies [4]. In a patient with a known placenta previa, the chance of having a placenta accreta with one prior cesarean delivery is 3.3 % and rises steadily with each additional cesarean delivery, up to 11 % with two prior cesarean deliveries and to 61 % with four prior cesarean deliveries [13]. In a case study of women with placenta previa, the rates of placenta accreta were even higher, 1.9 % with no prior cesarean deliveries, and up to 50 % with five prior cesarean deliveries [4].…”

Facteurs prédictifs d’échec de l’intention de voie basse chez la primipare obèse

“…En revanche, avoir une premiè re stagnation tardive, au-delà de 7 cm, semblait être de mauvais pronostic. L'é tude de Zhang et al nous permet d'é voquer une possible explication [23]. Aprè s avoir examiné le dé roulement du travail de 62 415 femmes de tout poids entré es en travail spontané ment, ils ont estimé que la duré e moyenne pour acqué rir un centimè tre de dilatation é tait de 1,3 h (95 e percentile : 6,4 h) entre 4 et 5 cm et de 0,8 h (95 e percentile : 3,2 h) entre 5 et 6 cm.…”

An evaluation of the indications for caesarean sections at Chris Hani Baragwanath Academic Hospital

“…[4,10] Recent data provide a better understanding of the active phase of labour where they infer that the active phase of labour only begins when the cervix is 6 cm dilated. [11][12][13] This concept of individualising labour management would have to be discussed nationally in SA, rather than be instituted at one facility.…”