Abstract
BackgroundThere is no available evidence for the prevalence of early labour admission to hospital or its association with rates of intervention and clinical outcomes in Australia. The objectives of this study were to: estimate the prevalence of early labour admission in one hospital in Australia; compare rates of clinical intervention, length of hospital stay and clinical outcomes for women admitted in early (< 4 cm cervical dilatation) or active (≥4 cm) labour; and determine the impact of recent recommendations to define early labour as < 5 cm on the findings.MethodsWe conducted a retrospective cohort study using medical record data from a random sample of 1223 women from live singleton births recorded between July 2013 and December 2015. Analyses included women who had spontaneous onset of labour at ≥37 weeks gestation whilst not a hospital inpatient, who had not scheduled a caesarean section before labour onset or delivered prior to hospital admission. Associations between timing of hospital admission in labour and clinical intervention, outcomes and hospital stay were assessed using logistic regression.ResultsBetween 32.4% (< 4 cm) and 52.9% (< 5 cm) of eligible women (N = 697) were admitted to hospital in early labour. After adjustment for potential confounders, women admitted in early labour (< 4 cm) were more likely to have their labour augmented by oxytocin (AOR = 3.57, 95% CI 2.39–5.34), an epidural (AOR = 2.27, 95% CI 1.51–3.41), a caesarean birth (AOR = 3.50, 95% CI 2.10–5.83), more vaginal examinations (AOR = 1.73, 95% CI = 1.53–1.95), and their baby admitted to special care nursery (AOR = 1.54, 95% CI = 1.01–2.35). Defining early labour as < 5 cm cervical dilatation produced additional significant associations with artificial rupture of membranes (AOR = 1.41, 95% CI = 1.02–1.95), assisted vaginal birth (AOR = 1.96, 95% CI = 1.12–3.41) neonatal resuscitation (AOR = 1.73, 95% CI = 1.01–2.99) and longer maternal hospital stay (AOR = 1.21, 95% CI = 1.04–1.40).ConclusionsFindings provide preliminary evidence that a notable proportion of labouring women are admitted in early labour and are more likely to experience several medical procedures, neonatal resuscitation and admission to special care nursery, and longer hospital stay.
Highlights
There is no available evidence for the prevalence of early labour admission to hospital or its association with rates of intervention and clinical outcomes in Australia
Eligible for inclusion in the study were women who gave birth in Caboolture Hospital in three chosen time periods1 where women [1] had a singleton pregnancy, [2] planned to have a vaginal birth, [3] had spontaneous onset of labour while not a hospital inpatient, [4] were at ≥37 weeks’
Women admitted in early labour were more likely to be primiparous (54.0%) than those admitted in active labour (38.5%; OR = 2.61, 95%Confidence Interval (CI) [1.88, 3.62], p < .001)
Summary
International guidelines recommend a delay in hospital admission during the early phase of labour by supporting women to stay at home [7, 8]. Despite these recommendations, and the overwhelming prevalence of early labour admissions, there are prevailing gaps in research to date. Differences in absolute rates of these interventions between women admitted in early and active labour vary widely between studies and evidence for the relationship between the timing of hospital admission and clinical outcomes is inconsistent or inconclusive. There is a paucity of Australian evidence for both the prevalence and outcomes of premature hospital admission in labour; the only Australian study [12] found reported on the relationship between timing of hospital admission in labour and just one outcome, caesarean section
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