Impact of Timing of Admission in Labour on Subsequent Outcome

Abstract

To examine the effect of timing at which women admitted either in active or latent phase of spontaneous labour on subsequent outcome. This cross-sectional study was conducted at labour ward, department of Obstetrics and Gynaecology, BSMMU hospital, Dhaka, Bangladesh, from August 2007 to November 2007, where data were collected prospectively. A total of 60 women with term, singletone pregnancy, cephalic presentation with spontaneous onset of labour admitted in labour either in active or latent phase were selected for evaluation. Patients with any medical or obstetric complications, rupture of membrane, antenatally diagnosed foetal anomalies or death and with prior caesarean section were excluded from the study. Patients with cervical dilatation at less than 4cm were categorized as latent phase and were in group I. On the other hand, patients with cervical dilatation of 4 cm or more were marked as in active phase and were allocated in group II. Baseline characteristics were compared. Outcome differences were compared using chisquare(X 2 ) test, t test, fisher's exact test, A 'p' value <0.05 considered significant. Duration of labour, mode of delivery, indication for caesarean section, need for oxytocin, labour analgesia, Apgar score <7, birth weight of baby, maternal PPH and postpartum hospital stay. A total of 60 patients were enrolled during the study period. Of them 35 patients (58.3%)were in group I and 25 patients (41.7%) in group II. Duration of labour was more in early admitted group compared to late admitted group (mean± SD 17.0 ± 2.8 vs 14.3 ± 2.4). Latent phase women needed more caesarean delivery than active phase women (62.9% vs 28.0%). Dystocia was the main indication for caesarean delivery in the present study which was 68.2% and 28.6% in early and late admitted group respectively. Second commonest indication for caesarean section was foetal distress (6 in group I and 5 in group II). Oxytocin for augmentation was used in 62.9% in group I and 56.0% in group II and nulliparae women were the one who needed more augmentation (40.0% in group I, 36.0% in group II). Mean foetal weight between two groups did not reach any significant difference (p>0.05). Apgar score <7 shows insignificant difference between two groups. PPH was found in 5.7% cases and all were from group I. Total postpartum hospital stay was significantly longer in group I than group II (p<0.05). t is shown that early admission to the hospital in low-risk women may negatively affect the outcome of labour and are at increased risk of prolonged labour, more need for analgesia, increased rate of caesarean section, increased PPH and postpartum hospital stay.

Labour management and Obstetric outcomes among pregnant women admitted in latent phase compared to active phase of labour at Bugando Medical Centre in Tanzania

“…This is similar to a study done in USA [7]. Regarding mode of delivery, studies in Bangladesh and Ethiopia found that normal vaginal delivery was significantly higher in active phase of labor than in latent phase of labor (p < 0.05), the finding which relate to this study (p < 0.006) [8,11]. …”

“…Perineal injury was found in 2(5.7%) and cervical tear was found in 1(2.9%) in latent phase of labor whereas no injury was found in active phase of labor in the study in Bangladesh [8]. PPH in the active phase group in this study occurred largely among primiparous women in approximately 50% of cases; thus the difference in labour complication pattern from other studies could be attributed to human resource constraints.…”

Does Admission in Labour Room During Latent Phase of Labour Versus Active Phase Really Matters in Low Risk Women Presenting at Term? A Cross-Sectional Observational Study

“…However our results were not consistent with the studies done by Albassam AN (58.3% vs 41.5% p < 0.05) [11] and Jessica Burns SN (80.4% vs 48.9%, p < 0.05) [12] . Regarding mode of delivery, our study found that normal vaginal delivery was statistically significantly higher in active phase of labor than in latent phase of labor which was similar to the study done by Janna et al [13] Caesarean section was more Section: Obstetrics & Gynaecology in latent phase compared to active phase of labor group in this study which is similar to study by Bailit J et al [8] . Leitch and Waker [14] demonstrated failure to progress remain the major indication underlying the decision to perform caesarean section followed by fetal indication.…”

“…Here major indication of caesarean section was dystocia which included failure to progress followed by fetal distress. On assessment of maternal complications, our study showed that more women had perineal tear (6.2%) and PPH (6.2%) in group 1, similar to this, Bailit JL et al [8] observed more cases of PPH (5.7%) in latent phase group and none was found in active phase group whereas Janna JR [13] observed no differences in PPH in the two groups. As compared to other studies, there was no difference between the birth weights but difference in outcome regarding asphyxia might have influenced by the strict exclusion criteria of the present study, which enrolled only low risk term pregnancy.…”

Variations in outcomes for women admitted to hospital in early versus active labour: an observational study

“…Evidence from large international retrospective cohort studies [1][2][3][4][5][6] suggests between 10.2% [1] and 58.5% [2] of women are admitted to hospital in latent phase ('early') labour. International guidelines recommend a delay in hospital admission during the early phase of labour by supporting women to stay at home [7,8].…”