On predicting time to completion for the first stage of spontaneous labor at term in multiparous women

BMC Pregnancy and Childbirth

Research Article

Jo Røislien¹  Ingibjörg Hanna Jónsdóttir²  Alexander Kr Smárason³  Björn Gunnarsson⁴  Eirik Skogvoll⁵ 

[1] Department of Health Studies, University of Stavanger, Stavanger, Norway;Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway;Department of Obstetrics and Gynecology, Akureyri Hospital, Akureyri, Iceland;Department of Obstetrics and Gynecology, Akureyri Hospital, Akureyri, Iceland;Institute of Health Science Research, University of Akureyri, Akureyri, Iceland;Department of Research, Norwegian Air Ambulance Foundation, Holterveien 24, 1448, Drøbak, Norway;Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway;

关键词: Labor progression;    Spontaneous labor;    Active labor;    Partogram;    Birthweight;    Body mass index;    Rupture of the membranes;    Robson’s classification;   

DOI  :  10.1186/s12884-017-1345-1

 received in 2016-12-14, accepted in 2017-05-24,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundLabor that progresses faster than anticipated may lead to unplanned out-of-hospital births. 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.MethodsWe performed a retrospective analysis of partograms for women in Robson’s group 3 who delivered at one hospital from 2003 to 2013. A generalized additive mixed model was fitted, accounting for possible non-linear relationships between the predictor variables and outcome, e.g. the time from each cervical measurement to full dilation, using multiple measurements for each woman. 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/m2), birthweight (kg), spontaneous rupture of membranes (no/yes). 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.ResultsA total of 1753 partograms were included in the analysis. The strongest predictors were birthweight, epidural and oxytocin use, and spontaneous rupture of membranes, along with cervical measurements. For birthweight, there was an almost 40% increase in time to full cervical dilation for each 1-kg increment. Conditional time was on average 23% longer in cases with epidural use and 53% longer in cases requiring oxytocin augmentation. Spontaneous rupture of the membranes shortened conditional time by 31%. Maternal age was not associated with the outcome, while increasing BMI and parity modestly reduced conditional time.ConclusionsHigher parity, lower fetal weight (gestational age), and spontaneous rupture of the membranes are associated with more rapid labor.

【 授权许可】

CC BY   
© The Author(s). 2017