The relationship between cervical dilatation at initial presentation in labour and subsequent intervention

Holmes, Paul; Oppenheimer, Lawrence; Wen, Shi Wu

doi:10.1111/j.1471-0528.2003.00265.x

Cited by 86 publications

(127 citation statements)

References 13 publications

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“…This finding is supported by prior reports that women admitted earlier (e.g., <4 cm dilatation) are approximately twice as likely to be augmented with oxytocin 34,35,38,39 and delivered via cesarean. 34–39 , when compared to women admitted later in labor.…”

Section: Commentsupporting

confidence: 85%

Differences in inflammatory markers between nulliparous women admitted to hospitals in preactive vs active labor

Neal

Lamp

Lowe

et al. 2015

American Journal of Obstetrics and Gynecology

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Objectives To determine if labor-associated inflammatory markers differ between low-risk, nulliparous women in pre-active vs. active labor at hospital admission and over time. Study Design Prospective comparative study of low-risk, nulliparous women with spontaneous labor onset at term (N=118) sampled from two large Midwestern hospitals. Circulating concentrations of inflammatory markers were measured at admission and again 2 and 4 hours later: namely, neutrophil and monocyte counts; and serum inflammatory cytokines (interleukin [IL]-1β, IL-6, tumor necrosis factor [TNF]-α, IL-10) and chemokines (IL-8). Biomarker concentrations and their patterns of change over time were compared between pre-active (n=63) and active (n=55) labor admission groups using Mann-Whitney U tests. Results Concentrations of IL-6 and IL-10 in the active labor admission group were significantly higher than concentrations in the pre-active labor admission group at all three time points. Neutrophil levels were significantly higher in the active group at 2 and 4 hours after admission. The rate of increase in neutrophils and IL-10 between admission and 2 hours later was faster in the active group (p<0.001 and p=0.003, respectively). Conclusions Circulating concentrations of several inflammatory biomarkers are higher and their rate of change over time since admission is faster among low-risk, nulliparous women admitted to hospitals in active labor, as compared to those admitted in pre-active labor. More research is needed to determine if progressive changes in inflammatory biomarkers might be a useful adjunct to improving the assessment of labor progression and determining the optimal timing of labor admission.

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Section: Commentsupporting

confidence: 85%

Differences in inflammatory markers between nulliparous women admitted to hospitals in preactive vs active labor

Neal

Lamp

Lowe

et al. 2015

American Journal of Obstetrics and Gynecology

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“…Based on these results, we surmise that hospitals may be performing cesarean deliveries to avoid turning away patients who do not arrive in active labor and who, having been rejected, do not return. Early arrival or early labor may be a C-section risk factor (in primigravida patients <3 cm dilated and multigesta 6 cm) [59]. …”

Section: Discussionmentioning

confidence: 99%

From therapeutic to elective cesarean deliveries: factors associated with the increase in cesarean deliveries in Chiapas

Freyermuth

Hernández

Ochoa

2017

Int J Equity Health

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BackgroundCesarean deliveries have increased over the past decade in Mexico, including those states with high percentages of indigenous language speakers, e.g., Chiapas. However, the factors contributing to this trend and whether they affect indigenous languages populations remain unknown. Thus, this work aims to identify some of the factors controlling the prevalence of cesarean sections (C-sections) in Chiapas between the 2011–2014 period.MethodsWe analyzed certified birth data, compiled by the Subsystem of Information on Births of the Secretary of Health and the National Institute of Statistics and Geography, and information regarding the Human Development Index (HDI), assembled by the United Nations Development Program. A descriptive analysis of the variables and a multilevel logistics regression model were employed to assess the role of the different factors in the observed trends.ResultsThe results show that the factors contributing to the increased risk of C-sections are (i) women residing in municipalities with indigenous population and municipalities with high HDIs, (ii) advanced schooling, (iii) frequent prenatal checkups, and (iv) deliveries occurring in private health clinics. Furthermore, C-sections might also be associated with prolonged hospital stays.ConclusionsThe increasing frequency of C-sections among indigenous populations in Chiapas seems to be related to public policies aimed at reducing maternal mortality in Mexico. Therefore, public health policy needs to be revisited to ensure that reproductive rights are being respected.

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“…Women admitted early (e.g., < 4 cm dilatation) are approximately twice as likely to be augmented with oxytocin when compared to women admitted in more active labor (1,2,34). Indeed, the rate of oxytocin use is inversely related to cervical dilatation at admission (r = −0.79, p < 0.05) (35).…”

Section: The Partographmentioning

confidence: 99%

Physiologic partograph to improve birth safety and outcomes among low-risk, nulliparous women with spontaneous labor onset

Neal¹,

Lowe²

2012

Medical Hypotheses

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Oxytocin augmentation and cesarean rates among low-risk, term, nulliparous women with a spontaneous onset of labor in the United States approximate 50% and 26.5%, respectively. This indicates that the quality of obstetrical care is much less than optimal in this nation. Exorbitant oxytocin use, the intervention most commonly associated with preventable adverse perinatal outcomes, jeopardizes birth safety while the high cesarean rate in this high-volume group compromises population health and increases health care costs. Dystocia, characterized by the slow, abnormal progression of labor, is the most commonly reported indication for primary cesareans, accounting directly for approximately 50% of all nulliparous cesareans and indirectly for most repeat cesareans. Diagnoses of dystocia are most often based on ambiguously defined delays in cervical dilation beyond which labor augmentation is deemed justified. Dystocia is known to be over-diagnosed which undoubtedly contributes to contemporary oxytocin augmentation and primary cesarean rates. Labor attendants would benefit from an evidence-based framework for homogenous labor assessment. To this end, we present a physiologically-based partograph for `in-hospital' use in assessing the labors of low-risk, term, nulliparous women with spontaneous labor onset. This tool incorporates several evidence-based labor principles that combine to give needed clinical meaning to `dystocia' as a diagnosis. It is hypothesized that our partograph will safely limit diagnoses of dystocia to only the slowest 10% of low-risk, nulliparous women. This should, in turn, safe-guard against unnecessary, injudicious, and potentially harmful use of oxytocin when labor is already adequately progressing while also indicating when its use may be justified. We further hypothesize that cesareans performed for dystocia in this population will decrease by ≥ 50%. No significant influence on other labor process or labor outcome variables is expected with partograph use. Widespread use of this physiologically-based partograph will be warranted if our hypotheses are supported.

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The relationship between cervical dilatation at initial presentation in labour and subsequent intervention

Abstract: Women who present to hospital at 0-3cm spend less time in labour before presentation and are more likely to have obstetric intervention than those presenting in more advanced labour. Outcomes were similar whether or not the woman was initially allowed home.

Cited by 86 publications

References 13 publications

Differences in inflammatory markers between nulliparous women admitted to hospitals in preactive vs active labor

Differences in inflammatory markers between nulliparous women admitted to hospitals in preactive vs active labor

From therapeutic to elective cesarean deliveries: factors associated with the increase in cesarean deliveries in Chiapas

Physiologic partograph to improve birth safety and outcomes among low-risk, nulliparous women with spontaneous labor onset

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