This is an incredible piece of research. If read and implemented, I think it could save SO MANY women from the pitocin-epidural-cesarean cascade. There is also an excellent review of the article on Academic OBGYN. Check it out! If you want the full article, shoot me an email or comment and I will send you a PDF. The formatting gets messed up if I try to post it here.
Enjoy!
The Natural History of the Normal First Stage of Labor
Zhang, Jun PhD, MD; Troendle, James PhD; Mikolajczyk, Rafael MD, MSc; Sundaram,
Rajeshwari PhD; Beaver, Julie MS; Fraser, William MD, MS
Obstetrics & Gynecology
Issue: Volume 115(4), April 2010, pp 705-710
DOI: 10.1097/AOG.0b013e3181d55925
Abstract
OBJECTIVE: To examine labor patterns in a large population and to explore an
alternative approach for diagnosing abnormal labor progression.
METHODS: Data from the National Collaborative Perinatal Project were used. A
total of 26,838 parturients were selected who had a singleton term gestation,
spontaneous onset of labor, vertex presentation, 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: The median time needed to progress from one centimeter to the next
became shorter as labor advanced (eg, from 1.2 hours at 3-4 cm to 0.4 hours at
7-8 cm in nulliparas). Nulliparous women had the longest and most gradual labor
curve; multiparous women of different parities had very similar curves.
Nulliparas may start the active phase after 5 cm of cervical dilation and may
not necessarily have a clear active phase characterized by precipitous dilation.
The deceleration phase in the late active phase of labor may be an artifact in
many cases.
CONCLUSION: The active phase of labor may not start until 5 cm of cervical
dilation in multiparas and even later in nulliparas. A 2-hour threshold for
diagnosing labor arrest may be too short before 6 cm of dilation, whereas a
4-hour limit may be too long after 6 cm. Given that cervical dilation accelerates
as labor advances, a graduated approach based on levels of cervical dilation to
diagnose labor protraction and arrest is proposed.
The Natural History of the Normal First Stage of Labor
Zhang, Jun PhD, MD; Troendle, James PhD; Mikolajczyk, Rafael MD, MSc; Sundaram,
Rajeshwari PhD; Beaver, Julie MS; Fraser, William MD, MS
Obstetrics & Gynecology
Issue: Volume 115(4), April 2010, pp 705-710
DOI: 10.1097/AOG.0b013e3181d55925
Abstract
OBJECTIVE: To examine labor patterns in a large population and to explore an
alternative approach for diagnosing abnormal labor progression.
METHODS: Data from the National Collaborative Perinatal Project were used. A
total of 26,838 parturients were selected who had a singleton term gestation,
spontaneous onset of labor, vertex presentation, 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: The median time needed to progress from one centimeter to the next
became shorter as labor advanced (eg, from 1.2 hours at 3-4 cm to 0.4 hours at
7-8 cm in nulliparas). Nulliparous women had the longest and most gradual labor
curve; multiparous women of different parities had very similar curves.
Nulliparas may start the active phase after 5 cm of cervical dilation and may
not necessarily have a clear active phase characterized by precipitous dilation.
The deceleration phase in the late active phase of labor may be an artifact in
many cases.
CONCLUSION: The active phase of labor may not start until 5 cm of cervical
dilation in multiparas and even later in nulliparas. A 2-hour threshold for
diagnosing labor arrest may be too short before 6 cm of dilation, whereas a
4-hour limit may be too long after 6 cm. Given that cervical dilation accelerates
as labor advances, a graduated approach based on levels of cervical dilation to
diagnose labor protraction and arrest is proposed.
1 comment:
the link doesn't work! can you repost what you are referring to! I love Academic OB/Gyn!!
Sharon
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