The shape of the classic Friedman curve is also contended because the average rate of cervical dilation appears to increase over time without distinct points of acceleration or deceleration. However, there is little consensus on the definitions of labor onset or the transition from latent to active phase. Many studies have examined the total length of the stages or phases of labor, or the median time of dilation in 1-cm integers (traverse time). Improved prediction of time to completion of dilation in this group could improve planning and management of transportation to birthing institutions. A majority of the women experiencing such births are multiparous women with singleton, cephalic pregnancies in spontaneous labor at term. We have studied unplanned out-of-institution births, which might occur because labor progresses faster than anticipated. Labor patterns vary widely, and both slow and fast labor are associated with complications. Higher parity, lower fetal weight (gestational age), and spontaneous rupture of the membranes are associated with more rapid labor. Maternal age was not associated with the outcome, while increasing BMI and parity modestly reduced conditional time. Spontaneous rupture of the membranes shortened conditional time by 31%. Conditional time was on average 23% longer in cases with epidural use and 53% longer in cases requiring oxytocin augmentation. For birthweight, there was an almost 40% increase in time to full cervical dilation for each 1-kg increment. The strongest predictors were birthweight, epidural and oxytocin use, and spontaneous rupture of membranes, along with cervical measurements. ResultsĪ total of 1753 partograms were included in the analysis. A modified regression model with gestational age (days) instead of birthweight was used to predict conditional time to full cervical dilation for combinations of the most relevant predictors. The following predictors were included: cervical dilation (cm), parity (1, 2, or ≥3 previous vaginal births), oxytocin infusion (no/yes), epidural (no/yes), maternal age (years), maternal height (cm), body mass index (BMI, kg/m 2), birthweight (kg), spontaneous rupture of membranes (no/yes). the time from each cervical measurement to full dilation, using multiple measurements for each woman. A generalized additive mixed model was fitted, accounting for possible non-linear relationships between the predictor variables and outcome, e.g. We performed a retrospective analysis of partograms for women in Robson’s group 3 who delivered at one hospital from 2003 to 2013. With the aim to improve planning of transportation to birthing institutions, this study investigated predictors of time to completion for the first stage of labor conditional on cervical opening (conditional time) in multiparous women at term. Labor that progresses faster than anticipated may lead to unplanned out-of-hospital births.
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