Analysis of spontaneous labor progression of breech presentation at term.

Ines Benmessaoud,Nicolas Mottet,Didier Riethmuller,Abdellah Hedjoudje,Aude Bourtembourg-Matras,Barbara Monard,Jean-Patrick Metz,Rajeev Ramanah,Margot Jamey,David Desseauve

doi:10.1371/journal.pone.0262002

Abstract

Cervical dilatation curves are widely used to describe normal and abnormal labor progression for cephalic presentation. Labor curves for breech presentations have never been described. The aims of this study were to examine the pattern of labor progression in women with a breech presentation and to determine whether the type of breech or parity can influence the speed of cervical dilatation. We analyzed the labor data from 349 women with a term, singleton, and breech fetus after spontaneous onset of labor in 2010-2018. Cesarean deliveries were excluded. The patterns of labor progression were described by examining the relationship between the elapsed times from the full dilatation and cervical dilatation stages. Average labor curves were developed using repeated-measures analysis with 3rd degree polynomial modeling. The results were interpreted according to parity and the type of breech. The first stage of labor progression was divided into a latency phase from 0 to 5 cm of dilatation and an active phase from 5 to 10 cm. In the active phase, the median speed of cervical dilatation was 1.67 cm/h [1.25, 2.61] (2 cm/h for multipara and 1.54 cm/h for nullipara). The difference by parity was significant in the active phase (p< 0.05). The cervical dilatation rate from 3 cm to 10 cm did not significantly differ between the complete and frank breeches (1.56 cm/h vs 1.75 cm/h, p = 0.48). However, the median cervical dilatation rate from 8 cm to complete dilatation was faster for complete breeches (1.92 cm/h versus 1.33 cm/h, p = 0.045). As with cephalic presentation, the first stage of labor progression for breech presentation can be divided into a latent and active phase. Labor progression should be interpreted with respect to parity, and women should be informed that the type of breech does not seem to influence the cervical dilatation rate when there is adequate management.

Highlights

Cervical dilatation curves are widely used to describe normal and abnormal labor progression
These data serve as a reference to define normal values for the first stage of labor progression, which can be divided into a latent phase and an active phase, which does not start until at least 5–6 cm of dilatation is observed [1]
The difference by parity was significant in the active phase (p< 0.05) but no significant differences were found in the rate of cervical dilatation across the types of breech

Summary

Introduction

Cervical dilatation curves are widely used to describe normal and abnormal labor progression. Referential data from the Consortium on Safe Labor for spontaneous deliveries are used for the management of labor progression to optimize recourses for obstetric interventions, such as the use of oxytocin and cesarean section [1, 2] These data serve as a reference to define normal values for the first stage of labor progression, which can be divided into a latent phase and an active phase, which does not start until at least 5–6 cm of dilatation is observed [1]. Because of the methodological limitations of these preliminary studies, Zhang et al reported contemporary curves developed with repeated-measures regression and polynomial function In this retrospective study, the 95th percentile rate of active phase dilatation for a vertex presentation varied from 0.5 cm/h to 0.7 cm/h for nulliparous women and from 0.5 cm/h to 1.3 cm/h for multiparous women.

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