Document Detail


Contemporary patterns of spontaneous labor with normal neonatal outcomes.
MedLine Citation:
PMID:  21099592     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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 more than 6 hours to progress from 4 to 5 cm and more than 3 hours to progress from 5 to 6 cm of dilation. Nulliparous and multiparous women appeared to progress at a similar pace before 6 cm. However, after 6 cm, labor accelerated much faster in multiparous than in nulliparous women. The 95 percentiles of the second stage of labor in nulliparous women with and without epidural analgesia were 3.6 and 2.8 hours, respectively. A partogram for nulliparous women is proposed.
CONCLUSION: In a large, contemporary population, the rate of cervical dilation accelerated after 6 cm, and progress from 4 cm 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.
Authors:
Jun Zhang; Helain J Landy; D Ware Branch; Ronald Burkman; Shoshana Haberman; Kimberly D Gregory; Christos G Hatjis; Mildred M Ramirez; Jennifer L Bailit; Victor H Gonzalez-Quintero; Judith U Hibbard; Matthew K Hoffman; Michelle Kominiarek; Lee A Learman; Paul Van Veldhuisen; James Troendle; Uma M Reddy;
Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, N.I.H., Extramural; Research Support, N.I.H., Intramural    
Journal Detail:
Title:  Obstetrics and gynecology     Volume:  116     ISSN:  1873-233X     ISO Abbreviation:  Obstet Gynecol     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-11-24     Completed Date:  2011-01-04     Revised Date:  2013-07-03    
Medline Journal Info:
Nlm Unique ID:  0401101     Medline TA:  Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1281-7     Citation Subset:  AIM; IM    
Affiliation:
Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892, USA. zhangj@mail.nih.gov
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MeSH Terms
Descriptor/Qualifier:
Female
Humans
Infant, Newborn
Labor Stage, First
Labor Stage, Second
Labor, Obstetric*
Parity
Pregnancy
Pregnancy Outcome
Reference Values
Grant Support
ID/Acronym/Agency:
HHSN267200603425C/HD/NICHD NIH HHS; HHSN267200603425C//PHS HHS
Comments/Corrections

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