Background
Controversy surrounds the definition of “normal” and “abnormal” labor.
Objective
In this study, we used contemporary labor charts to explore labor patterns in large
obstetric population (2011–2016).
Study Design
Detailed information from electronic medical records of live singleton deliveries
at term (≥37 weeks of gestation) was extracted. Cases of elective cesarean deliveries,
nonvertex presentation, and cesarean deliveries during the first stage of labor were
excluded.
Results
Overall, 35,146 deliveries were included, of whom 15,948 deliveries (45.3%) were of
nulliparous women. Median cervical dilation at admission was not significantly different
between nulliparous (median, 4 cm; interquartile range, 3–5 cm) and multiparous women
(median, 4 cm; interquartile range, 3–6 cm). In all, 99.3% of the women delivered
vaginally. For nulliparous women, the median duration of the first stage of labor
was 274 minutes (interquartile range, 145–441 minutes; 95th percentile, 747.5 minutes).
Likewise, for multiparous women, the corresponding duration was 133 minutes (interquartile
range, 56–244 minutes; 95th percentile, 494 minutes). During the latent phase (cervical
dilation at admission, ≤4 cm), the time elapsed to the second stage of labor was 120–140
minutes longer in nulliparous women, whereas the gap between the groups decreased
dramatically with advanced cervical dilation on admission. Nulliparous and multiparous
women appeared to progress at a similar pace during the latent phase; however, after
5 cm, labor accelerated faster in multiparous women. Epidural anesthesia lengthens
duration first and second stages of labor in all parities. Partograms according to
cervical dilation at presentation are proposed.
Conclusion
Cervical dilation rate is relatively constant between nulliparous and multiparous
pregnant women during the latent phase. Time interval of the first stage was far slower
than previously described, which allowed labor to continue for a longer period during
this stage. These findings may reduce the rate of intrapartum iatrogenic interventions.
Key words
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Article info
Publication history
Published online: September 28, 2019
Accepted:
September 23,
2019
Received in revised form:
September 17,
2019
Received:
June 18,
2019
Footnotes
The authors report no conflict of interest.
Cite this article as: Ashwal E, Livne MY, Benichou JIC, et al. Contemporary patterns of labor in nulliparous and multiparous women. Am J Obstet Gynecol 2020;222:267.e1-9.
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© 2019 Elsevier Inc. All rights reserved.
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- March 2020 (vol. 222, no. 3, page 267)American Journal of Obstetrics & GynecologyVol. 223Issue 6
