Prolonged Latent Phase Of Labor Research Articles

Efficacy of Propranolol to Reduce Cesarean Delivery in Prolonged Labor: A Randomized Controlled Trial.

To evaluate the rates of cesarean delivery in patients with prolonged labor randomized to receive intravenous (IV) propranolol compared with placebo. A double-blind, placebo-controlled, randomized trial was conducted at two hospitals within a large academic health system. Eligible patients were at 36 weeks or more with a singleton gestation and prolonged labor , defined as: 1) prolonged latent phase of labor (dilation less than 6 cm after 8 hours or more with ruptured membranes and receiving oxytocin infusion) or 2) prolonged active phase of labor (dilation 6 cm or greater and less than 1-cm cervical dilation change over 2 hours or more with ruptured membranes and receiving oxytocin infusion). Patients were excluded for severe preeclampsia, maternal heart rate less than 70 beats per minute, maternal blood pressure less than 90/50 mm Hg, asthma, diabetes requiring insulin during labor, or a cardiac contraindication to β-blockade. Patients were randomized to propranolol (2 mg IV) compared with placebo (2 mL normal saline IV), with one possible repeat dose. The primary outcome was cesarean delivery; secondary outcomes included labor duration, shoulder dystocia, and maternal and neonatal morbidity. With an estimated cesarean delivery rate of 45%, α 0.05, and 80% power, we required 163 patients per group to detect a 15% absolute reduction in cesarean delivery rate. A planned interim analysis was performed, and the trial was stopped for futility. From July 2020 to June 2022, 349 patients were eligible and approached; 164 were enrolled and randomized, with 84 in the propranolol group and 80 in the placebo group. The rate of cesarean delivery was not different between groups (57.1% propranolol vs 57.5% placebo, relative risk [RR] 0.99, 95% CI 0.76-1.29). Results were similar by subgroup of prolonged latent (n=123) and active (n=41) phases of labor and nulliparous (n=137) and multiparous (n=27) patients. Though not statistically significant, the frequency of postpartum hemorrhage was higher in the propranolol group (20% vs 10%, RR 2.02, 95% CI 0.93-4.43). In this multisite, double-blind, placebo-controlled randomized trial, there was no difference in cesarean delivery rate for patients who received propranolol compared with those who received placebo for management of prolonged labor. ClinicalTrials.gov , NCT04299438.

How long is too long? Assessing risks of prolonged latent phase of labor

How long is too long? Assessing risks of prolonged latent phase of labor

Hematocervix as an Uncommon Complication of Cesarean Delivery: A Case Report

Hematometra is a condition of retained blood or clot in the uterus. If just the cervix is affected by collection, the condition is described as hematocervix. The hematocervix should be suspected in a women with amenorrhea and recurrent lower abdominal pain. The objective of this case report was to report a rare case of isolated hematocervix following cesarean delivery.A 27-years-old primigravidae woman was admitted with the complaints of severe pelvic pain and amenorrhea. She had the history of full term delivery via cesarean section because of prolonged latent phase of labor almost 3 months ago. Pelvic examination, transvaginal sonography and MRI findings were confirmed the diagnosis of hematocervix cervical dilatation and curettage following vaginal misoprostol was done and the women was discharged with good health status.The increased rates of cesarean delivery in all over the world caused increase in rare complication such as isolated hematocervix. Dilatation and drainage of cervical collection is safe and effective treatment in such cases.

Induction of labor compared to expectant management in term nulliparas with a latent phase of labor of more than 8\u2009hours: a randomized trial

BackgroundProlonged latent phase of labor is associated with adverse maternal and neonatal outcomes. Preliminary data indicate that labor induction for prolonged latent phase may reduce cesarean delivery. We performed a study powered to Cesarean delivery to evaluate labor induction compared to expectant management in full term nulliparas hospitalized for persistent contractions but non-progressive to established labor after an overnight stay.MethodsFrom 2015 and 2017, nulliparas, ≥ 39 weeks’ gestation with prolonged latent phase of labor (persistent contractions after overnight hospitalization > 8 h), cervical dilation ≤3 cm, intact membranes and reassuring cardiotocogram were recruited. Participants were randomized to immediate induction of labor (with vaginal dinoprostone or amniotomy or oxytocin as appropriate) or expectant management (await labor for at least 24 h unless indicated intervention as directed by care provider). Primary outcome measure was Cesarean delivery.ResultsThree hundred eighteen women were randomized (159 to each arm). Data from 308 participants were analyzed. Cesarean delivery rate was 24.2% (36/149) vs. 23.3%, (37/159) RR 1.0 95% CI 0.7–1.6; P = 0.96 in induction of labor vs. expectant arms. Interval from intervention to delivery was 17.1 ± 9.9 vs. 40.1 ± 19.8 h; P < 0.001, intervention to active labor 9.6 ± 10.2 vs. 29.6 ± 18.5 h; P < 0.001, active labor to delivery 7.6 ± 3.6 vs. 10.5 ± 7.2 h; P < 0.001, intervention to hospital discharge 2.4 ± 1.2 vs. 2.9 ± 1.4 days; P < 0.001 and dinoprostone use was 19.5% (29/149) vs. 8.2% (13/159) RR 2.4 95% CI 1.3–4.4; P = 0.01 in IOL compared with expectant arms respectively. Intrapartum oxytocin use, epidural analgesia and uterine hyperstimulation syndrome, postpartum hemorrhage, patient satisfaction on allocated intervention, during labor and delivery and baby outcome were not significantly different across trial arms.ConclusionsInduction of labor did not reduce Cesarean delivery rates but intervention to delivery and to hospital discharge durations are shorter. Patient satisfaction scores were similar. Induction of labor for prolonged latent phase of labor can be performed without apparent detriment to expedite delivery.Trial registrationRegistered in Malaysia National Medical Research Register (NMRR-15-16-23,886) on 6 January 2015 and the International Standard Randomised Controlled Trials Number registry, registration number ISRCTN14099170 on 5 Nov 2015.

Women's labour experiences and quality of care in relation to a prolonged latent phase of labour

AimTo describe primiparous and multiparous women's labour experiences and their perception of quality of intrapartum care, in relation to background characteristics and length of latent phase of labour prior to admittance to labour ward. DesignA cross-sectional study. SettingA middle-sized hospital in a rural county in western part of Sweden. ParticipantsPrimiparous and multiparous women, both low-risk and risk, with a spontaneous onset of labour after gestational week 37+0 were included. In total, n = 1193 women were invited, and n = 757 responded the questionnaire, n = 342 primiparous and n = 415 multiparous women. MethodsThe Intrapartal-specific Quality from Patient Perspective (QPP-I), with responses on perceived reality and subjective importance, was used for data collection. QPP-I covers ten factors of quality of care. Background characteristics, length of latent phase of labour, global items about labour experience and items regarding feelings during labour and birth were included. Data were analysed with descriptive and analytic statistics. FindingsAll factors in QPP-I were rated higher for subjective importance than perceived reality, except for information about selfcare, for both primi- and multiparous women. Labour experience, perceived reality of quality of care, and feelings were related to length of the latent phase of labour. Primiparous women with a prolonged latent phase (>18 h) had significantly lower scores regarding six out of ten QPP-I factors (PR); Information procedures, Information self-care, Commitment (midwives), Commitment (enrolled nurses), Midwives present, and Partner/ significant others. They scored lower on Experience birth as normal and Safe during labour and birth. The felt less proud and felt more ignored by professionals. Multiparous women with a prolonged latent phase of labour scored significantly lower on one QPP-I factor, Commitment (midwives). They also scored lower on Control over the situation and felt less safe during labour and birth. Key ConclusionWomen's perception of quality of intrapartum care, the birth experience and feelings are related to length of the latent phase of labour. Women perceive quality of intrapartum care as being lower than its subjective importance. Implications for PracticeA prolonged latent phase of labour can be regarded as a risk factor for a more negative birthing experience.

Prevalence of Prolonged Latent Phase and Labor Outcomes: Review of Birth Records in a Swedish Population.

The prevalence of a prolonged latent phase of labor has been described as ranging from 5% to 6.5% in previous research. The aim of this study was to describe the prevalence of the prolonged latent phase of 18 hours or more, based on women's report, in women intending vaginal birth and who had spontaneous onset of labor. An additional aim was to compare the incidence of obstetric interventions, and the labor and neonatal outcomes in women with and without a prolonged latent phase. A descriptive and comparative study was performed in a mid-sized hospital in western Sweden. The sample consisted of 1343 birth records of women who intended vaginal births and who had spontaneous onset of labor at 37 or more weeks' gestation during a one-year period (2013-2014). Background characteristics, obstetric interventions, and labor and neonatal outcomes were compared between women with latent phases lasting less than 18 hours and 18 hours or more, based on women's self-report. Odds ratios with 95% confidence intervals were calculated for the different exposure variables. A prolonged latent phase lasting 18 hours or more occurred in 23% of all births analyzed (n = 1343). A prolonged latent phase was more common among nulliparous women (29.2%) but also common for multiparous women (17%). Nulliparous and multiparous women who experienced a prolonged latent phase were more often exposed to amniotomy during latent phase. For nulliparous women, the adjusted odds ratio (aOR) was 11.57 (95% confidence interval [CI], 5.25-25.51) and for multiparous women the aOR was 18.73 (95% CI, 9.06-38.69). Similarly, amniotomy during active phase was more common for both nulliparous and multiparous women who experienced a prolonged latent phase (aOR, 4.05; 95% CI, 2.53-6.47 and aOR, 3.93; 95% CI, 2.43-6.37, respectively). Women with latent phases of 18 hours or more, more often experienced augmentation of labor during all phases, especially during latent phase. For nulliparous women, the aOR was 10.13 (95% CI, 2.82-36.39) and for multiparous women, aOR was11.9 (95% CI, 3.69-38.71). A prolonged latent phase was associated with more instrumental vaginal births for multiparas (aOR, 2.58; 95% CI, 1.27-5.26) and emergency cesarean regardless of parity (nulliparous women: aOR, 3.21; 95% CI, 1.08-9.50 and multiparous women: aOR, 3.93; 95% CI, 1.67-9.26). Based on women's self-report, the prevalence of a prolonged latent phase in women at term who planned a vaginal birth and had spontaneous onset of labor was higher than previously reported. Women with a prolonged latent phase were more likely to receive obstetric interventions. Assisted vaginal birth was more common for nulliparous women with prolonged latent phase and emergency cesarean occurred more frequently for both nulliparous women and multiparous women with a prolonged latent phase.

Primiparous women's preferences for care during a prolonged latent phase of labour

ObjectiveTo investigate primiparous women's preferences for care during a prolonged latent phase of labour. MethodsA qualitative study based on focus groups and individual interviews and analysed with inductive content analysis. ResultsSixteen primiparous women with a prolonged latent phase of labour >18 hours were interviewed in five focus groups (n = 11) or individually (n = 5). One main category emerged “Beyond normality – a need of individual adapted guidance in order to understand and manage an extended latent phase of labour” which covers the women's preferences during the prolonged latent phase. Five categories were generated from the data: “A welcoming manner and not being rejected”, “Individually adapted care”, “Important information which prepares for reality and coping”, “Participation and need for feedback” and “Staying nearby the labour ward or being admitted for midwifery support”. Women with a prolonged latent phase of labour sought to use their own resources, but their needs for professional support increased as time passed. A welcoming attitude from an available midwife during the latent phase created a feeling of security, and personally adapted care was perceived positively. ConclusionsWomen with a prolonged latent phase of labour preferred woman-centred care. Midwives play an important role in supporting these women. Women's need for midwifery-support increases as the time spent in latent phase increases.

The Latent Phase of Labor: Diagnosis and Management

The latent phase of labor is complex and not completely understood by modern science. Studies often ignore evaluation of this phase of labor because determination of onset is subjective. In this article, the definition and time parameters of latent phase labor are discussed, and generalized distinctions between prelabor and labor are evaluated. Outpatient relief measures for latent phase as well as inpatient medical interventions for prolonged latent phase of labor are reviewed. Recommendations for policy development are included along with a discussion about the need to consider the significance of time limits. For optimal outcomes, clinicians are encouraged to individualize a management plan that is made in collaboration with the laboring woman.

Maternal and fetal outcome after a prolonged latent phase of labour

Context : Prolonged latent phase of labour is reportedly associated with labour dystocia and neonatal morbidity. There are few published work on prolonged latent phase and none from this environment. Objective : To determine if prior labour ward admission with prolonged latent is a predictor of labour dystocia and neonatal morbidity. Methods : The course and outcome of active phase labour in One hundred and twenty-eight patients with a prior prolonged latent phase was compared with 896 patients who went into active phase labour without a prolonged latent phase. Relevant data was retrieved from the departmental obstetric data bank. Outcome measures : Labour augmentation, Caesarean section and instrumental delivery rates, Apgar scores and neonatal hospital admission. Results : Labour augmentation and Caesarean rates were higher and labour was longer among the cases than controls. (50.5 vs 36.4%: P=0.0001, 27.3 vs 7.0%: P=0001 and 7.6 vs 6.2 hrs: P=0.0028 respectively). Blood loss at delivery was more and neonatal hospital admission was more frequent among the cases than controls. Conclusion : Prolonged latent phase of labour is a predictor of labour dystocia and neonatal morbidity. Keywords : outcome, maternal, fetal, prolonged latent phase of labour Tropical Journal of Obstetrics and Gynaecology Vol. 22(2) 2005: 171-176

Maternal and fetal risks associated with prolonged latent phase of labour

A pregnancy cohort study was undertaken to assess the fetal, maternal and obstetric risks associated with the prolonged latent phase of labour. One hundred and fifty cases (latent phase >8 hours) were compared with 100 controls (latent phase <8 hours). Data were collected from hospital records. There were more nulliparas in the case group (73% vs. 39%; P <0·0001). Cases required oxytocin augmentation (62% vs. 17%; P <0·0001) and caesarean section (29% vs. 6%; P <0·0001) more frequently than controls. Thick meconium staining of the liquor was more frequent in cases (15% vs. 5%; P <0·05), as were 5-minute Apgar scores less than 7 (17% vs. 3%; P <0·001) and admission to the neonatal unit (22% vs. 1%; P <0·0001). Prolonged latent phase is associated with increased risks for obstetric intervention and poor fetal outcome. The optimal management of prolonged latent phase is still unknown and requires further study by means of randomised controlled trials.