Abstract
ObjectiveTo investigate associations between cervical dilatation at hospital admission and mode of delivery. MethodsA cohort study with data from a cluster-randomised controlled trial, the Labour Progression Study. The study population of 6511 nulliparous women with a singleton fetus in cephalic presentation with spontaneous onset of labour at term, was divided into two groups: <4 cm and ≥ 4 cm cervical dilatation on admission. Binary logistic regression comparing mode of delivery was used to estimate crude and adjusted OR with associated 95% CI. ResultsOf the total study population, 56.7% were admitted with < 4 cm cervical dilatation and 43.3% with ≥ 4 cm. Women admitted with ≥ 4 cm had a significantly higher chance of spontaneous delivery, with adjusted OR of 1.28 (95% CI: 1.14–1.44), and a significantly lower risk of caesarean sections, with an adjusted OR of 0.51 (95% CI: 0.41–0.64). For operative vaginal delivery, there were no significant difference between the study groups. Intrapartum interventions as epidural analgesia and augmentation with oxytocin were lower among women admitted with ≥ 4 cm cervical dilatation. ConclusionThe study found a significantly higher chance of spontaneous delivery among women admitted with ≥ 4 cm. More research is needed to investigate why so many women are admitted early in labour, and how these women can be better cared for to increase their chances of a spontaneous delivery.
Highlights
The optimal timing for hospital admission of women in labour is an important research and policy question for labouring women, as well as for doctors and midwives
A larger proportion of women with < 4 cm cervical dilatation on admission was found in the group aged 25–34 years, while women admitted with ≥ 4 cm had higher representation in the groups < 25 years and ≥ 35 years
Women admitted with ≥ 4 cm cervical dilatation had a significantly higher chance of spontaneous delivery than women admitted with < 4 cm, as demon strated in previous studies [11,12,13]
Summary
The optimal timing for hospital admission of women in labour is an important research and policy question for labouring women, as well as for doctors and midwives. In Norway, women are advised to stay at home until they reach the active phase of labour. Many seek hospital admission in the latent phase, and several are admitted. Cervical dilatation is a commonly used parameter in determining a woman’s current stage of labour. Today’s expectations to the cervical dilatation process, and the woman’s progression in labour date back to the work of Dr Emanuel Friedman in the 1950 s [2]. Based on Friedman’s cervicograph, Philpott developed the basis for today’s partograph, where active labour and its expected progress were considered to commence at 4 cm cervical dilatation [3]. About 60 years after Friedman presented his work, Zhang et al presented an alternative curve, where the start of the active phase is ‘delayed’ until 6 cm dilatation [4]
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