Cm Of Cervical Dilatation Research Articles

Parto vaginal después dos cesáreas. ¿Es una práctica segura?

Introduction: A widely held belief is that a mother who has had a cesarean section will no longer be able to deliver vaginally; however, there is evidence that it is possible even with two or more previous cesarean sections. Objective: To describe the results of vaginal delivery after one and two previous cesarean sections in a secondary care hospital in Djibouti. Methods: A descriptive, longitudinal study was conducted, which included patients with one or two previous cesarean sections more than two years ago, in labor, with no condition contraindicating transpelvic delivery. Results: All patients with two previous cesarean sections, and 96.9% of those with one previous cesarean section, were delivered with more than 4cm of cervical dilation. When the Flamm score was applied, 18 of the 33 patients with a previous cesarean section had a high probability of success if vaginal delivery was continued. The overall success rate with one previous cesarean section was 78.8%, and 87.5% with a history of two cesarean sections. There were 8 complications, 7 of which occurred in patients with only one previous cesarean section. The most frequent complication was immediate postpartum hemorrhage. Conclusions: The frequency of successful vaginal delivery after one or two cesarean sections was high. The prediction was more accurate for the group with two previous cesarean sections, although in both groups, when the Flamm score was high, vaginal delivery was almost always possible.

The amplitude of low-frequency fluctuations is correlated with birth trauma in patients with postpartum post-traumatic stress disorder

Postpartum post-traumatic stress disorder (PP-PTSD) is a severe mental disorder worldwide. In recent years, some studies have reported that PP-PTSD stems from birth trauma. The present study was dedicated in finding ways to predict the occurrence of emergency caesarean section (ECS), trying to analyze the methods to reduce incidence of PP-PTSD on this basis, further exploring the neuroimaging changes in PP-PTSD. A total of 245 primiparas with intention of vaginal delivery were recruited. The internal tocodynamometry measurement was performed during labor for all mothers, and respectively taken at 3–5 cm, 5–8 cm, and 8–10 cm of cervical dilation. The receiver operating characteristic (ROC) curve and Binary logistic regression analyses were also performed to identify fetal head descending thrust that might help in the prediction of ECS. Resting-state magnetic resonance imaging (MRI) was performed on 26 patients diagnosed with PP-PTSD of 245 mothers, the amplitude of low-frequency fluctuations (ALFF) technology was used to observe the spontaneous neural activity of all PP-PTSD patients and correlation analyses were performed. We found that the natural delivery rate of mothers with fetal head descending thrust <16.29 N (5–8 cm), 26.36 N (8–10 cm) were respectively lower than other mothers with fetal head descending thrust ≥16.29 N (5–8 cm), 26.36 N (8–10 cm) (P < 0.05). The ROC curve analysis showed that the area under the receiver operating characteristic curve (AUC) value of thrust (5–8 cm) was 0.896 (95% CI: 0.854–0.938, p < 0.001), AUC of thrust(8–10 cm) was 0.786 (95% CI: 0.714–0.858, p < 0.001), which showed strong potential for predicting ECS. In addition, the Binary logistic regression analysis showed thrust (5-8 cm) and thrust (8–10 cm) were independent correlates of ECS. The resting-state functional magnetic resonance imaging (rs-fMRI) results indicated that PP-PTSD group showed decreased ALFF in the bilateral insula cortex (IC), right anterior cingulate cortex (ACC), and left midcingulate cortex (MCC) compared with healthy postpartum women (HPW) (false discovery rate (FDR) correction q-value < 0.05). The ALFF value of the right ACC was positively correlated with the Perinatal Post-traumatic stress disorder Questionnaire (PPQ) score (r = 0.4046 p = 0.0403) and Posttraumatic Stress Disorder Checklist–Civilian Version (PCL–C) score (r = 0.3909 p = 0.0483). The internal tocodynamometry measurement can serve as a predictive tool for ECS, on this basis, the implementation of effective emotional support may help to reduce the incidence of PP-PTSD. Besides, this study has verified the presence of altered ALFF in the brain regions of PP-PTSD patients, mainly involving the bilateral IC, right ACC, and left MCC, that might be associated with emotion, cognition, and memory disorders functions in PP-PTSD patients.

Continued versus discontinued oxytocin stimulation in the active phase of labour (CONDISOX): individual management based on artificial intelligence - a secondary analysis

BackgroundCurrent guidelines regarding oxytocin stimulation are not tailored to individuals as they are based on randomised controlled trials. The objective of the study was to develop an artificial intelligence (AI) model for individual prediction of the risk of caesarean delivery (CD) in women with a cervical dilatation of 6 cm after oxytocin stimulation for induced labour. The model included not only variables known when labour induction was initiated but also variables describing the course of the labour induction.MethodsSecondary analysis of data from the CONDISOX randomised controlled trial of discontinued vs. continued oxytocin infusion in the active phase of induced labour. Extreme gradient boosting (XGBoost) software was used to build the prediction model. To explain the impact of the predictors, we calculated Shapley additive explanation (SHAP) values and present a summary SHAP plot. A force plot was used to explain specifics about an individual’s predictors that result in a change of the individual’s risk output value from the population-based risk.ResultsAmong 1060 included women, 160 (15.1%) were delivered by CD. The XGBoost model found women who delivered vaginally were more likely to be parous, taller, to have a lower estimated birth weight, and to be stimulated with a lower amount of oxytocin. In 108 women (10% of 1060) the model favoured either continuation or discontinuation of oxytocin. For the remaining 90% of the women, the model found that continuation or discontinuation of oxytocin stimulation affected the risk difference of CD by less than 5% points.ConclusionIn women undergoing labour induction, this AI model based on a secondary analysis of data from the CONDISOX trial may help predict the risk of CD and assist the mother and clinician in individual tailored management of oxytocin stimulation after reaching 6 cm of cervical dilation.

Snoezelen therapy for pain, labor outcome and maternal satisfaction among parturient at tertiary hospital, South India

IntroductionLabor is a physiological process that causes severe discomfort, leading to maternal dissatisfaction. Snoezelen therapy, a multisensory complementary therapy, promotes comfort and relaxation by releasing endorphins, thereby improving satisfaction during the labor process. ObjectiveTo assess the effectiveness of Snoezelen therapy on pain perception, labor outcomes, and maternal satisfaction among parturients. MethodsAn experimental pretest-posttest control design was conducted among 74 parturient selected using consecutive sampling techniques in South India. Baseline observations were obtained at the beginning of the active stage, after which the study group parturient were subjected to Snoezelen therapy until reaching 10cm of cervical dilatation. Hourly assessments of pain, using a numerical pain scale, were performed. Labor outcomes were measured in terms of labor duration and mode of delivery. Maternal satisfaction with the birth experience and satisfaction with Snoezelen therapy components were collected 24 h after delivery. Descriptive and inferential statistics were used for data analysis. ResultsA statistically significant decrease in pain perception (p < 0.001) and an increase in maternal satisfaction (p < 0.001) were noted among parturient who underwent Snoezelen therapy. Parturient expressed high satisfaction with the use of aroma, music, and massage. There was no statistical significance in the duration of delivery and mode of delivery between the study and control groups. ConclusionSnoezelen therapy reduces pain perception and increases maternal satisfaction during the active stage of labor. Thus, Snoezelen therapy can be implemented as part of nursing care during the labor process.

Rebozo Technique on Pain Intensity in the First Stage of the Active Phase and Length of Labor in Multigravida Mothers, Wanayasa District, Purwakarta Regency, Indonesia

Background: Pain during the first stage of the active phase is one of the main obstacles in the labor process. The rebozo technique, a traditional technique from Mexico, has been proven to be effective in reducing labor pain. This study aims to determine the effectiveness of the rebozo technique on the intensity of pain in the first stage of the active phase and the duration of labor in multigravida mothers in Wanayasa District, Purwakarta Regency.&#x0D; Methods: This research used a quasi-experimental design with a pre-test and post-test with a control group design. The research sample was 60 multigravida mothers who were divided into two groups: the intervention group (n=30), who received the rebozo technique, and the control group (n=30), who received standard care. Pain intensity was measured using the visual analogue scale (VAS) and duration of labor was calculated from 4 cm of cervical dilatation to complete dilation.&#x0D; Results: The results showed that there was a significant difference in the intensity of pain during the first active phase between the intervention group and the control group (p=0.001). The mean pain intensity in the intervention group was lower than the control group (VAS: 4.2 ± 1.5 vs. 6.1 ± 1.8). There was no significant difference in length of labor between the two groups (p=0.123).&#x0D; Conclusion: The rebozo technique is effective in reducing the intensity of pain during the first active phase in multigravida mothers but has no effect on the length of labor.

UTILITY OF PAPERLESS PARTOGRAM IN LABOR MANAGEMENT

Objective: To compare WHO-modified partograph and paperless partogram in the effective management of labor. Methods: A prospective analytical study was carried out in the Department of Obstetrics and Gynecology, Pannadhay Zanana Hospital at RNT Medical College, Udaipur. A sample of 400 pregnant women was recruited by random sampling from the labor room, for 1 year (June 01, 2021, to May 31, 2022). Women fulfilling inclusion criteria were randomly assigned for monitoring of labor in an active phase of labor ≥ 4 cm of cervical dilatation. Results: The mean age was 26.46 ± 3.90 years with an age range of 18–37 years, 65% were rural. 11% crossed alert line and 1.5% crossed action line. 94.75% had a normal vaginal delivery and 21 (5.25%) cases had lower segment cesarean section (LSCS). As indication for LSCS 16 (76.19%) had fetal distress and 5 (23.81%) had secondary arrest of dilatation and descent head. 17 (4.25%) had APGAR &lt;7 at 5 min and no stillbirth was reported. Conclusion: We concluded that the paperless partogram was effective and user-friendly in the management of labor and prevention of abnormal or prolonged labor when compared to the WHO partogram in low-risk cases.

Effect of maternal hyperoxygenation on neonatal outcomes among women in labour with pathological cardiotocography: an open-label randomized controlled trial

Hyperoxygenation has shown promise in improving suspicious fetal heart patterns in women in labor. However, the effect of hyperoxygenation on neonatal outcomes in women in labor with pathologic fetal heart rate tracing has not been studied. This study aimed to evaluate the effect of fractional inspiration of oxygen of 80% compared with fractional inspiration of oxygen of 40% on neonatal outcomes in women with pathologic fetal heart rate tracing. This randomized, open-label, parallel arm, outcome assessor-blinded clinical trial was conducted in a large tertiary care university hospital. Singleton parturients aged ≥18 years at term gestation in active labor (cervical dilatation of ≥6 cm) with pathologic fetal heart rate tracing were recruited in the study. Pathologic fetal heart rate tracing was defined according to the International Federation of Gynecology and Obstetrics 2015 guidelines. The International Federation of Gynecology and Obstetrics classifies fetal heart rate tracings into 3 categories (normal, suspicious, and pathologic) based on rate, variability, and deceleration. Women in the intervention arm received oxygen at 10 L/min via a nonrebreathing mask, and those in the usual care arm received oxygen at 6 L/min with a simple face mask. Oxygen supplementation was continued until cord clamping. The primary outcome measure was a 5-minute Apgar score. The secondary outcome measures were the proportion of neonatal intensive care unit admission, umbilical cord blood gas variables, level of methyl malondialdehyde in the cord blood, and mode of delivery. Overall, 148 women (74 women in the high fractional inspiration of oxygen arm and 74 in the low fractional inspiration of oxygen arm) with pathologic fetal heart rate tracing were analyzed. The demographic data, obstetrical profiles, and comorbidities were comparable. The median 5-minute Apgar scores were 9 (interquartile range, 8-10) in the hyperoxygenation arm and 9 (interquartile range, 8-10) in the usual care arm (P=.12). Furthermore, the rate of neonatal intensive care unit admission (9.5% vs 12.2%; P=.6) and the requirement of positive pressure ventilation (6.8% vs 8.1%; P=.75) were comparable. Concerning cord blood gas parameters, the hyperoxygenation arm had a significantly higher base deficit in the umbilical vein and lactate level in the umbilical artery. The cesarean delivery rate was significantly lower in women who received hyperoxygenation (4.1% [3/74]) than in women who received normal oxygen supplementation (25.7% [19/74]) (P=.00). In addition, umbilical vein malondialdehyde level in the umbilical vein was lower in the hyperoxygenation group (8.28±4.65 μmol/L) than in the normal oxygen supplementation group (13.44±8.34 μmol/L) (P=.00). Hyperoxygenation did not improve the neonatal Apgar score in women with pathologic fetal heart rate tracing. In addition, neonatal intensive care unit admission rate and blood gas parameters remained comparable. Therefore, the results of this trial suggest that a high fractional inspiration of oxygen supplementation confers no benefit on neonatal outcomes in women with pathologic fetal heart rate tracings and normal oxygen saturation.

Intrauterine Vacuum-Induced Haemorrhage-Control Device: A Novel Approach For Pph.

Madam, Postpartum haemorrhage (PPH), defined as postpartum blood loss of &gt; 1000 mL, is a life-threatening emergency and the leading cause of maternal mortality accounting for 25% of maternal deaths worldwide (1). PPH can lead to significant morbidity, including shock, ARDS, coagulopathy, infertility due to hysterectomy, and even mortality (4). Uterine atony is the most common cause, accounting for 80% of all cases of PPH (1) (2). Active management of the third stage of labour consisting of a triad of oxytocin, controlled cord traction, and uterine massage can reduce the incidence of PPH by 60% (5). If abnormal uterine bleeding ensues, PPH protocols are activated, including uterine balloon tamponade, uterine packing, uterine artery embolization, or hysterectomy (1, 2). The Jada System (novel intrauterine vacuum-induced haemorrhage-control device) approved by the U.S. FDA in August 2020, utilizes a low-level vacuum to induce negative pressure in the uterine cavity that facilitates uterine contraction to constrict myometrial blood vessels that can help with uterine atony (1). The device is used in patients with PPH where standard PPH treatments have failed or are contraindicated (1). It is a soft medical-grade silicone that attenuates the risk of tissue trauma and can be placed trans-vaginally after 3 cm of cervical dilation after vaginal birth and C-section (1,2). Ultrasound is used to check correct device placement, along with real-time quantification of the expelled blood from the uterine cavity into the graduated canister. The device can be placed for 1.5 hours to 24 hours inside the uterus. The device can be removed after evaluation of evacuated blood and palpation for a firm uterus, both signifying control of the hemorrhage (2). A First-in-Human (FIH) feasibility study conducted in Indonesia on 10 participants with atony-related PPH showed that the device was placed effectively, and bleeding was controlled in under 2 minutes with no unfavorable outcome in any participants (1) (3). The study was conducted with 107 participants of which two-thirds had atony-related PPH with failed medical treatment (1). The Per Protocol showed a 99% success rate in effectively controlling PPH (2). Bleeding halted in a minimum of 3 minutes, the treatment duration was around 3.2 hours and 98% of users regarded it as convenient to use (1). Adverse events included endometritis and vaginal infections all of which were resolved with adequate treatment (2). ---Continue

Pain Intensity, coping and maternal satisfaction in Low-Risk labouring Women: A prospective descriptive correlational study

ObjectivesThe primary aim of the study was to explore pain intensity (PI) and pain coping (PC) scores and the relationship between them. The secondary aim was to explore the correlation between PI and PC scores with labour progress, parity, labour acceleration, labour augmentation and maternal satisfaction. MethodsA prospective descriptive correlational study was conducted in a maternity hospital in Northern Italy. The sample included 54 low-risk women in active labour at term of pregnancy. A data record sheet was used to collect the relevant variables and the Italian Birth Satisfaction Scale Revised (I-BSS-R) was administered to participants at least 24 h after birth. ResultsIn the first labour stage, the average PI score was 6.99 (SD = 1.95) and the average PC score was 6.5 (SD = 2.22). During the second labour stage, the average PI score was 7.75 (SD = 1.74) and the average PC score was 4.97 (SD = 2.76). The average PI score trend increased with labour progress. The average PC score improved between 4 and 7 cm of cervical dilatation. A significant positive correlation between PI scores and oxytocin augmentation (p < 0.001) and labour progression (p < 0.001) was noted. A significant positive correlation between PC scores and oxytocin augmentation (p = 0.02) was also observed. No significant differences were found for maternal satisfaction in regard to PI and PC scores. Conclusioncoping in labour do not solely depend on PI but also on labour progress and oxytocin augmentation. Additional support to empower women to cope with pain may be required in case of labour augmentation.

Rapid Amniotic Fluid Assessment for Cervical Cerclage Placement

A 22-year-old female whose first pregnancy resulted in the delivery of a full-term healthy newborn presented at 20 weeks gestation in her second pregnancy for urgent maternal fetal consultation. A recent ultrasound diagnosed a short cervix of 20 mm. A pelvic exam revealed 1 to 2 cm of cervical dilation and the urgent need for cervical cerclage placement to reduce the risk of preterm delivery and fetal demise. Amniocentesis was carried out, and cultures, glucose, and lactate dehydrogenase testing were performed on the amniotic fluid to quickly exclude chorioamnionitis prior to the operation (Table 1). ... ... Amniotic fluid glucose and lactate dehydrogenase test results can aid physicians when assessing the risk of ascending infection before cerclage placement and are available within hours compared to cultures (2–3 days). Median glucose and lactate dehydrogenase concentrations in intraamniotic infections are 4.5 mg/dL and 1084 IU/L, respectively (1, 2). Glucose <15 mg/dL and lactate dehydrogenase > 250 U/L demonstrate 73.3%/57% sensitivity and 88.1%/87% specificity, respectively for chorioamnionitis (3, 4). Our patient did not have an infection. Common culture isolates include Ureaplasma urealyticum and Mycoplasma hominis (5).

Applying a physiotherapy protocol to women during the active phase of labor improves obstetrical outcomes: a randomized clinical trial

BACKGROUNDLabor is a physiological process triggered by mechanical and hormonal events that promote uterine contractions to expel the fetus. OBJECTIVEThis study aimed to evaluate the effectiveness of a nonpharmacologic childbirth care protocol in women in the active phase of labor in improving obstetrical and perinatal outcomes. STUDY DESIGNThis was a randomized trial with concealed allocation, assessor blinding, and intention-to-treat analysis. A total of 80 low-risk primigravida women at the end of pregnancy admitted at the beginning of the active phase of labor participated in the study. The participants were divided into an experimental group (n=40) and a control group (n=40). Women in the experimental group received 4 interventions: ambulation at 4 to 6 cm of cervical dilation, alternation of maternal postures, transcutaneous electrical nerve stimulation at 6 to 7 cm, and a warm shower bath at >7 cm. The control group received only routine obstetrical care during labor. The parturient could request pharmacologic analgesia at any time during the study. The main outcome measures were the duration of the active phase of the first stage of labor, the duration of the expulsive phase of labor, and the prevalence of labor dystocia as assessed by the partograph. The researchers collected other maternal and neonatal data from official birth records. RESULTSThe parturients who received the nonpharmacologic protocol had a shorter active phase of the first stage of labor (444 minutes in the control group and 373 minutes in the experimental group; P=.02), presented rupture of membranes later in labor (7 cm in the control group and 8 cm in the experimental group; P<.01), requested pharmacologic analgesia with more significant cervical dilation (5 cm in the control group and 8 cm in the experimental group; P<.01), requested fewer additional doses of analgesics, and had lower labor dystocia rates than the patients in the control group. In addition, there was no difference in other maternal and perinatal variables between the control group and the experimental group. CONCLUSIONThe implementation of a sequential nonpharmacologic protocol composed of ambulation, transcutaneous electrical nerve stimulation with change of upright positions, and warm shower bath has the potential to reduce labor pain, as reflected in decreased and delayed use of pharmacologic analgesia and reduced duration of the active phase of labor and dystocia rates. Maternity hospitals should provide this protocol, and women should be encouraged to request this childbirth care protocol.

The effect of cold application to the sacral area on labor pain and labor process: A randomized controlled trial

Aim: This study aims to determine the effect of cold application to the sacral area in the first stage of labor on labor pain and process.Materials and Methods: The study was done as a randomized controlled experimental study. While the women in the experimental group received cold application for 10 minutes every 20 minutes after 4 cm of cervical dilatation, the women in control group received routine care protocol of the unit.Results: The pregnant women in experimental group showed statistically significantly low score of pain on the 40th (p=0.041), 100th (p&amp;lt;0.001), and 160th (p=0.014) minutes and had statistically significantly shorter delivery time (p&amp;lt;0.001) in comparison to the control group. It was also found that dilatation and effacement happened in statistically significantly shorter time in the experimental group (p&amp;lt;0.05).Conclusion: Cold application to the sacral area of pregnant women in the first stage of labor reduces labor pain, shortens labor time, and shortens dilatation and effacement time.

Identification of Contractions from Electrohysterography for Prediction of Prolonged Labor.

The analysis of the uterine electrical activity and its propagation patterns could potentially predict the risk of prolonged/arrested progress of labor. In our study, the Electrohysterography (EHG) signals of 83 participants in labor at around 3-4 cm of cervical dilatation, were recorded for about 30 minutes each. These signals were analyzed for predicting prolonged labor. Out of the 83 participants, 70 participants had normal progress of labor and delivered vaginally. The remaining 13 participants had prolonged/ arrested progress of labor and had to deliver through a cesarean section. In this paper, we propose an algorithm to identify contractions from the acquired EHG signals based on the energy of the signals. The role of contraction consistency and fundal dominance was evaluated for impact on progress of the labor. As per our study, the correlation of contractions was higher in case of normal progress of labor. We also observed that the upper uterine segment was dominant in cases with prolonged/arrested progress of labor.

Labour epidural practice in a tertiary training centre

Dear Editor, Labour analgesia provided through the central neuraxial approach is offered for parturients who are in their active stage of labour, usually after 2–4cm of cervical dilatation. Lumbar epidural, the gold standard for labour analgesia, is recently recommended over other alternative methods of analgesia such as pressurised gaseous nitrous oxide, to minimise aerosol-related risks

Development of and Experiences With an Informational Website on Early Labor: Qualitative User Involvement Study.

BackgroundThe period of regular contractions before 4 cm of cervical dilatation is often referred to as the latent phase or early labor. Women find it challenging to prepare for and cope with this phase of labor, and easily accessed web-based information from reliable sources may be useful in this preparation.ObjectiveThe aim of this study is to describe the development of a Norwegian website, Latens.no, for people seeking information on early labor and to explore users’ experiences with the website to increase its user-friendliness.MethodsWe developed a website using an iterative process involving a multidisciplinary research team, health personnel, users, a graphic designer, and an expert in software development. We explored the website’s user-friendliness using semistructured individual interviews and the think-aloud method. All interviews were audio recorded and transcribed. We then analyzed the participants’ feedback on the website.ResultsParticipants included women who had recently given birth to their first baby (n=2), women who were pregnant with their first baby (n=4), and their partners (n=2). Results from participants’ experiences completing tasks included positive feedback related to the content of Latens.no, positive feedback related to the website’s design, and suggestions for improvement. Participants wanted to find information on early labor on the internet. Moreover, they found the information on the website relevant, trustworthy, and easy to read, and the design was attractive and easy to use. Overall, the participants performed the tasks easily, with few clicks and minimal effort.ConclusionsThe think-aloud method, while performing tasks, allowed for detailed feedback. The participants confirmed the user-friendliness of the website but at the same time provided information enabling improvement. We expect that changes made based on this user-centered design study will further increase the usability and acceptability of Latens.no.

Considering Criteria for Active Phase Labor Management of Nulliparous Women: A Cost-Effectiveness Analysis.

The aim of the study is to evaluate differences in maternal and neonatal outcomes based on updated criteria for defining active labor at 6 cm of cervical dilation and to determine if these recommendations are cost-effective. A decision-analytic model was built using TreeAge Pro 2020 software. We included maternal outcomes of mode of delivery, endometritis, postpartum hemorrhage requiring transfusion, and death. Neonatal outcomes included rates of shoulder dystocia and permanent brachial plexus injury. Costs and quality-adjusted life years (QALYs) were included from the maternal and infant perspectives. We used a willingness-to-pay threshold of $100,000 per QALY and all model inputs were subjected to sensitivity analysis. In a theoretical cohort of 1.4 million women, a threshold of 6 cm to define active labor resulted in 373,668 fewer cesarean deliveries, 33,181 fewer cases of endometritis, 143 fewer postpartum hemorrhages requiring transfusions, and seven fewer maternal deaths when compared with a threshold of 4 cm. However, there were higher rates of adverse neonatal outcomes, including 484 more cases of shoulder dystocia and 17 more instances of permanent brachial plexus injury. Using 6 cm as the threshold resulted in lower costs and greater effectiveness, making it a dominant strategy. Multivariate sensitivity analysis demonstrated the model was robust over a wide range of assumptions. In this model, considering 6 cm of cervical dilation as the threshold for the active phase of labor compared with 4 cm was a cost-effective strategy to prevent primary cesarean deliveries, lower costs, and improve maternal outcomes, despite associated increased adverse neonatal outcomes. · Cervical dilation of 6 cm should be considered the threshold for the active phase of labor. This is a change from the prior definition of 4 cm.. · We built a theoretical model to compare outcomes and costs associated with the new active phase definition of 6 cm.. · Using a 6-cm threshold is a cost-effective strategy for decreasing primary cesarean deliveries..

Progression of the first stage of labour, in low risk nulliparas in a South Asian population: a prospective observational study

We compared the labour pattern in the active phase of labour, defined at 4 cm versus 6 cm cervical dilatation, in a South Asian population. This was a prospective observational study where 500 low risk nulliparous women were recruited. Our aim was to study, the average labour pattern curve of all parturients. Mean duration of the active phase from 4 to 10 cm was 5.12 ± 2.10 hours and from 6 to 10 cm was 2.79 ± 1.72 hours. The 95th percentile values suggests that it takes 5–6 hours to progress from 4 to 6 cm and again 5–6 hours from 6 to 10 cm. The minimum labour progression rate can be as low as 0.5 cm/hour with vaginal delivery (VD) still being achieved. The slope of labour curve steepens after 6 cm, suggesting 6 cm as the onset of the active phase. Allowing labour to continue for a longer period before 6 cm of cervical dilation may reduce the rate of unnecessary intrapartum intervention and caesarean section (CS) for labour dystocia. Impact Statement What is already known on this subject ? Friedman’s definitions of normal labour and abnormal labour are widely accepted in current obstetric practises. Friedman’s normal dilatation rate of 1 cm/h that is universally accepted is becoming questionable in our current obstetric population because of escalating rates of unnecessary labour interventions like oxytocin augmentation and CS. What the results of this study add ? The rule of 1 cm/hour of labour progression cannot be applied to every woman and inappropriate interventions should be withheld until labour progression does falls below 0.5 cm/hour. What the implications are of these findings for clinical practice and/or further research? Six centimetres rather than 4 cm of cervical dilatation is a more appropriate landmark for the start of the active phase. Allowing labour to continue for a longer period before 6 cm of cervical dilation may reduce the rate of unnecessary intrapartum interventions and CS for labour dystocia.

Fetal lactate levels align with the stage of labour

AimTo evaluate the association between lactate concentrations in fetal blood samples and the different advanced labour stages. MethodsEighteen-month prospective population-based clinical study of 187 singleton pregnant women in labour who were monitored by fetal blood sampling (FBS) because of non-reassuring intrapartum CTG results at Kuopio University Hospital, Finland. Peripheral lactate concentration and pH were analysed at different stages of labour and in umbilical arterial samples immediately after delivery. ResultsFBS samples (N = 350) were obtained from 5.4 % of all women in labour during the study period, and 48 % had spontaneous delivery, 27 % had vacuum-assisted vaginal delivery, and 25 % had nonelective Caesarean delivery. FBS lactate levels increased 4–11% with every 1–2 cm of cervical dilation and 18 % from early labour to fully dilated cervix. In 42 women with at least two FBSs, lactate levels increased significantly from the early I stage of labour and up to a fully dilated cervix. Lactate values were significantly higher in umbilical arterial samples compared to FBSs. Sensitivity of the highest FBS lactate values for the detection of birth asphyxia were considerably low varying between 42.9–57.1%. ConclusionFBS lactate levels were related to the stage of labour during vaginal delivery attempt. Wide range of lactate levels during labour complicates its use as a predictor of birth asphyxia.

Epidural analgesia during labor and its optimal initiation time-points: A real-world study on 400 Chinese nulliparas.

Recent research has suggested that 6 cm of cervical dilation should be the threshold for the active labor phase, and it has confirmed that epidural analgesia (EA) is a safe method of pain relief during labor. However, the evidence provided for these findings comes mainly from randomized controlled clinical trials (RCTs), which suffer from the limitation of real-world generalizability.To test the generalizability of the conclusions from these previous RCTs, we conducted a prospective cohort, real-world study (RWS) on 400 Chinese term nulliparas. A total of 200 of the participants (the EA group) received EA upon request. The participants in the EA group were further subdivided as follows according to their cervical dilation when the EA administration was initiated (CDE): [EA1 group (CDE < 3 cm), EA2 group (3 cm ≤ CDE < 6 cm), and EA3 group (CDE ≥ 6 cm)]. We compared the labor duration of the EA group versus the non-EA (NEA) group, and the NEA group versus the 3 EA subgroups. We also compared delivery outcomes between the EA and NEA groups.The median total labor duration for the EA group [676 (511–923) minutes] was significantly longer than that of the NEA group [514 (373–721) minutes] (P < 0.001). The median durations of both the first- and second-stages of labor for the EA group [600 (405–855) minutes, 68 (49–97) minutes] were longer than those of the NEA group [420 (300–630) minutes, 50 (32–85) minutes] (P < .001, P < .001)]. In addition, the median total labor durations in both the EA1 [720 (548–958) minutes] and EA2 groups [688 (534–926) minutes] were longer than in the NEA group (P < .001 and P < .001, respectively), and the first- and second-stage labor durations of these subgroups were similar to their total labor durations. A Cox regression analysis showed that EA was associated with longer first-stage labor [hazard ratio (HR) 0.55, 95% confidence interval (CI) 0.42–0.71, P < .001] and longer second-stage labor (HR 0.66, 95% CI 0.51–0.85, P = .001). The delivery modes and neonatal outcomes between the EA and NEA groups were not statistically different, however.Our findings suggest that EA administered before a cervical dilation of 6 cm may be associated with longer total, first-, and second-stage labor durations compared with no EA, while later EA administration is not. In addition, though EA prolongs labor duration, it does not impact delivery outcomes. These results confirm the significance of a 6 cm cervical dilation threshold in real-world labor settings.

Novel device vs manual examinations for the measurement of cervical dilation in labor: a randomized controlled trial

Cervical dilation and changes in cervical dilation inform the management of labor, including decisions to admit a patient to the hospital, augment labor, or perform a cesarean delivery. Practitioners routinely measure cervical dilation subjectively using 2 fingers on manual examination; however, agreement of ≤1 cm between 2 observers has been reported as 60% to 91% previously in laboring women. To evaluate the agreement among different providers' examinations using DilaCheck (interexaminer agreement) compared with interexaminer agreement between 2 manual examinations for cervical dilation of women in labor. Women admitted in labor to a labor and delivery service were randomized to receive 2 cervical examinations from trained providers, using either a novel device (DilaCheck) or the standard manual examination. This randomized controlled trial compares a novel device with the standard method of manual examination for the measurement of cervical dilation. The novel device consisted of a string measuring tape suspended between 2 soft plastic rings worn on the index and middle fingertips. Interobserver agreement, defined as the agreement (exact, ≤1 cm [primary outcome], or ≤2 cm) in the numeric cervical dilation measurement obtained by 2 different examiners, was compared between the 2 groups. A total of 42 women in labor were randomized, 21 to the novel device and 21 to the standard manual examination groups. The 2 device examinations agreed in 19% of cases, whereas manual examinations agreed exactly in 42.9% of cases (P=.10). Interobserver agreement of ≤1 cm was 61.9% vs 95.2%, respectively (P=.008). Interobserver agreement of ≤2 cm was 90.5% vs 100%, respectively (P=.15). Most interobserver disagreement was seen at 5 to 7 cm of cervical dilation. A novel device, DilaCheck, intended for a more objective cervical assessment of women in labor did not improve interobserver agreement; in fact, it decreased it. Standard cervical dilation examinations result in poor interexaminer exact agreement, usually at best 50% or less. Clinical management should be based on clinical differences of >1 cm because, in general, 90% of cervical examinations will agree within 1 cm of each other. Given the importance of dilation measurements in the management of labor, continued innovation in this field would benefit women in labor and the providers caring for them; however, the puzzle remains unsolved.