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

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

Labor 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...

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Bibliographic Details
Published in:BMC pregnancy and childbirth Vol. 17; no. 1; p. 183
Main Authors: Gunnarsson, Björn, Skogvoll, Eirik, Jónsdóttir, Ingibjörg Hanna, Røislien, Jo, Smárason, Alexander Kr
Format: Journal Article
Language:English
Published: England BioMed Central 12-06-2017
BMC
Subjects:
Active labor
Adult
Age
Anesthesia, Epidural
Birth Weight
Births
Birthweight
Body Height
Body Mass Index
Childbirth & labor
Extraembryonic Membranes
Female
Forecasting - methods
Generalized linear models
Humans
Labor progression
Labor Stage, First
Maternal Age
Midwifery
Models, Statistical
Obesity
Obstetrics
Oxytocics - administration & dosage
Oxytocin - administration & dosage
Parity
Partogram
Pregnancy
Retrospective Studies
Spontaneous labor
Statistical analysis
Term Birth
Time Factors
Variables
Womens health
Labor progression
Spontaneous labor
Body mass index
Rupture of the membranes
Birthweight
Active labor
Partogram
Robson’s classification
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Summary:Labor 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. We 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/m ), 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. A 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. Higher parity, lower fetal weight (gestational age), and spontaneous rupture of the membranes are associated with more rapid labor.
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ISSN:1471-2393
1471-2393
DOI:10.1186/s12884-017-1345-1