Prediction of Duration of Active Labor in Nulliparous Women at Term

Maddalena Incerti; Anna Locatelli; Alessandro Ghidini; Elena Ciriello; Silvia Malberti; Sara Consonni; John C. Pezzullo

doi:10.1055/s-2007-1004827

American Journal of Perinatology, Inhaltsverzeichnis

Am J Perinatol 2008; 25(2): 085-089
DOI: 10.1055/s-2007-1004827

Prediction of Duration of Active Labor in Nulliparous Women at Term

Maddalena Incerti¹ , Anna Locatelli¹ , Alessandro Ghidini¹ , Elena Ciriello¹ , Silvia Malberti¹ , Sara Consonni¹ , John C. Pezzullo²

¹Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
²Department of Pharmacology and Biostatistics, Georgetown University, Washington, D.C.

Abstract

ABSTRACT

We have assessed the independent predictors of duration of active labor in nulliparous women at term. Using a cohort of 1067 nulliparae in spontaneous labor at > 37.0 weeks with singleton fetuses in vertex presentation, multivariate analysis was used to identify independent predictors of duration of active labor. Duration of active labor was 4.1 ± 2.4 hours. Stepwise linear regression selected 10 independent predictors of duration of active labor: gestational age at delivery (p < 0.001), race (p = 0.014), obstetric risk factors (p = 0.022), amniotomy (p < 0.001), fundal height (p = 0.005), cervical dilation on admission (p < 0.001), frequency of contractions (p < 0.001), station of presenting part (p < 0.001), oxytocin (p < 0.001), and epidural use (p < 0.001). A prediction formula incorporating the 10 predictors accounted for 51% of the total variance of the observed duration of active labor. Ten variables are independent predictors of duration of active labor; when incorporated in a prediction formula they account for > 50% of the variability of duration of labor in nulliparous women.

KEYWORDS

Active labor - nulliparous - partogram - curve of labor - prolonged labor

Volltext

Referenzen

REFERENCES

1 Philpott R H, Castle W M. Cervicographs in the management of labour in primigravidae. J Obstet Gynaecol Br Commonw. 1972a; 79 599-602
2 Philpott R H, Castle W M. Cervicographs in the management of labour in primigravidae. J Obstet Gynaecol Br Commonw. 1972b; 79 592-598
3 Friedman E A. Labor in multiparas: A graphicostatistical analysis. Obstet Gynecol. 1956; 8 691-703
4 Friedman E A. Labor: Clinical Evaluation and Management. New York; Appleton-Century-Crofts 1978
5 Beazley J M, Kurjak A. Influence of a partograph on the active management of labor. Lancet. 1972; 19 348-351
6 Menticoglou S M, Manning F, Harman C, Morrison I. Perinatal outcome in relation to second-stage duration. Am J Obstet Gynecol. 1995; 173 906-912
7 Rouse D J, Owen J, Hauth J C. Active-phase labor arrest: oxytocin augmentation for at least 4 hours. Obstet Gynecol. 1999; 93 323-328
8 Rouse D J, Owen J, Savage K G, Hauth J C. Active phase labor arrest: revisiting the 2-hour minimum. Obstet Gynecol. 2001; 98 550-554
9 Impey L, Hobson J, O'Herlihy C. Graphic analysis of actively managed labor: prospective computation of labor progression in 500 consecutive nulliparous women in spontaneous labor at term. Am J Obstet Gynecol. 2000; 183 438-443
10 Rinehart B K, Terrone D A, Hudson C, Isler C M, Larmon J E, Perry Jr K G. Lack of utility of standard labor curves in the prediction of progression during labor induction. Am J Obstet Gynecol. 2000; 182 1520-1526
11 Zhang J, Troendle J, Yancey M K. Reassessing the labor curve in nulliparous women. Am J Obstet Gynecol. 2002; 187 824-828
12 Devoe L D, Samuel S, Prescott P, Work B A. Predicting the duration of the first stage of spontaneous labor using a neural network. J Matern Fetal Med. 1996; 5 256-261
13 Albers L L. The duration of labor in healthy women. J Perinatol. 1999; 19 114-119
14 Zhang J, Yancey M K, Klebanoff M A, Schwarz J, Schweitzer D. Does epidural analgesia prolong labor and increase risk of cesarean delivery? A natural experiment. Am J Obstet Gynecol. 2001; 185 128-134
15 Boylan P. Intrapartum fetal monitoring. Baillieres Clin Obstet Gynaecol. 1987; 1 73-95
16 Albers L L, Shiff M, Gorwoda J G. The length of active labor in normal pregnancies. Obstet Gynecol. 1996; 87 355-359
17 Tuck S M, Cardozo L D, Studd J WW, Gibb D MF. Obstetric characteristics in different racial groups. Br J Obstet Gynaecol. 1983; 90 892-897
18 Thorp J A, Hu D H, Albin RM, et al.. The effect of intrapartum epidural anesthesia on nulliparous labor: A randomized, controlled prospective trial. Am J Obstet Gynecol. 1993; 169 851-858
19 Alexander J M, Sharma S K, McIntire D D, Leveno K J. Epidural analgesia lengthens the Friedman active phase of labor. Obstet Gynecol. 2002; 100 46-50
20 Clark A, Carr D, Loyd G, Cook V, Spinnato J. The influence of epidural analgesia on cesarean delivery rates: a randomized, prospective clinical trial. Am J Obstet Gynecol. 1998; 179 1527-1533
21 Salim R, Nachum Z, Moscovici R, Lavee M, Shalev E. Continuous compared with intermittent epidural infusion on progress of labor and patient satisfaction. Obstet Gynecol. 2005; 106 301-306
22 Nuthalapaty F S, Rouse D J, Owen J. The association of maternal weight with cesarean risk, labor duration, and cervical dilation rate during labor induction. Obstet Gynecol. 2004; 103 452-456
23 Vahratian A, Zhang J, Troendle J F, Savitz D A, Siega-Riz A M. Maternal prepregnancy overweight and obesity and the pattern of labor progression in term nulliparous women. Obstet Gynecol. 2004; 104 943-951
24 O'Driscoll K, Stronge J M, Minogue M. Active management of labor. BMJ. 1973; 3 135-137

Maddalena IncertiM.D.

Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Via Solferino 16

20052 Monza (MI), Italy; reprints not available from the author