Normal labor curve in twin gestation

Hochler, Hila; Guedalia, Joshua; Lipschuetz, Michal; Walfisch, Asnat; Friedman, Efrat Guedalia; Unger, Ron; Sergienko, Ruslan; Yoles, Israel; Kabiri, Doron; Cohen, S. M.

doi:10.1016/j.ajog.2021.07.019

Cited by 6 publications

(8 citation statements)

References 15 publications

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“…Earlier studies found that different subgroups of parturients progress differently during labor, e.g., twin labors [ 5 ]. Customized partograms for different subgroups of parturients may potentially lower the rates of CDs due to protraction disorders.…”

Section: Introductionmentioning

confidence: 99%

Partogram of Grandmultiparous Parturients: A Multicenter Cohort Study

Guedalia

Lipschuetz

Walfisch

et al. 2023

JCM

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Sparse and conflicting data exist regarding the normal partogram of grand-multiparous (GMP, defined as parity of 6+) parturients. Customized partograms may potentially lower cesarean delivery rates for protraction disorders in this population. In this study, we aim to construct a normal labor curve of GMP women and compare it to the multiparous (MP, defined as parity of 2–5) partogram. We conducted a multicenter retrospective cohort analysis of deliveries between the years 2003 and 2019. Eligible parturients were the trials of labor of singletons ≥37 + 0 weeks in cephalic presentation with ≥2 documented cervical examinations during labor. Exclusion criteria were elective cesarean delivery without a trial of labor, preterm labor, major fetal anomalies, and fetal demise. GMP comprised the study group while the MP counterparts were the control group. A total of 78,292 deliveries met the inclusion criteria, comprising 10,532 GMP and 67,760 MP parturients. Our data revealed that during the first stage of labor, cervical dilation progressed at similar rates in MPs and GMPs, while head descent was a few minutes faster in GMPs compared to MPs, regardless of epidural anesthesia. The second stage of labor was faster in GMPs compared to MPs; the 95th percentile of the second stage duration of GMPs (48 min duration) was 43 min less than that of MPs (91 min duration). These findings remained similar among deliveries with and without epidural analgesia or labor induction. We conclude that GMPs’ and MPs’ cervical dilation progression in the active phase of labor was similar, and the second stage of labor was shorter in GMPs, regardless of epidural use. Thus, GMPs’ uterus function during labor corresponds, and possibly surpasses, that of MPs. These findings indicate that health providers can use the standard partogram of the active phase of labor when caring for GMP parturients.

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Section: Introductionmentioning

confidence: 99%

Partogram of Grandmultiparous Parturients: A Multicenter Cohort Study

Guedalia

Lipschuetz

Walfisch

et al. 2023

JCM

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“…Further research is needed to determine whether patients undergoing a trial of labor with a macrosomic neonate have a different partogram, such as has been described in twin deliveries. 18 Another reason why our study demonstrated high TOLAC success in both study groups may be since our study population was created based on neonatal birth weights and not estimated fetal weight. It has been well described that fetal weight estimations do not correlate well with actual birth weights, particularly in patients with macrosomia.…”

Section: Discussionmentioning

confidence: 87%

“…This may affect the threshold for terminating the trial of labor due to a failure to progress, and extra time is given to the patients to progress, facilitating more patients to achieve VBAC with no increase in adverse neonatal and maternal outcomes. Further research is needed to determine whether patients undergoing a trial of labor with a macrosomic neonate have a different partogram such as has been described in twin deliveries 18 Another reason why our study demonstrated high TOLAC success in both study groups may be since our study population was created based on neonatal birthweights and not estimated fetal weight. It has been well described that fetal weight estimations do not correlate well with actual birthweights, particularly in patients with macrosomia.…”

Section: Accepted Manuscriptmentioning

confidence: 91%

A Trial of Labor after Cesarean Section with a Macrosomic Neonate. Is It Safe?

et al. 2022

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Objective: To determine whether a trial of labour after caesarean section (TOLAC) with a macrosomic neonate is associated with adverse outcomes. Methods A retrospective cohort study was conducted in a population motivated for TOLAC. Women attempting TOLAC with a neonatal birthweight >4000g were compared to women attempting TOLAC with neonatal birthweights between 3500g-4000g. The primary outcome was TOLAC success. Secondary outcomes included mode of delivery, uterine rupture, postpartum haemorrhage (PPH), shoulder dystocia, obstetric anal sphincter injury (OASI), Apgar <7 at 5 min and umbilical artery pH <7.1). Data were analysed using Fisher's exact test and chi‐square tests. Results 375 women who underwent TOLAC with a neonate weighing >4000 g comprised the study group. 1783 women attemtpting TOLAC with a neonate weighing 3500-4000g comprised the control group. There were no clinically significant differences between the groups for maternal age, gestational age, parity and VBAC rate. There were no significant differences in the rates of successful TOLAC (94% versus 92.3%, P = 0.2, OR = 0.8, 95% CI 0.5–1.2), operative vaginal delivery (7.4% versus 5.3%, P = 0.18, OR 0.7, 95% CI 0.4–1.1), uterine rupture (0.4% versus 0% P = 0.6), PPH (3.2% Vs 2.3 % p=0.36 OR 1.4 CI 0.7,2.7) , OASI (0.8% Vs 0.2% p=0.1 OR 3.6 CI 0.8,1.6), Apgar <7 at 5 mins (0% Vs 0.4% p=0.37) and umbilical artery pH <7.1 (0.5% Vs 0.7% p=1.0 OR 0.73 CI 0.2,3.2) Women with a neonate weighing > 4000 g had a significantly increased risk of shoulder dystocia (4% Vs 0.4% p <0.05, OR 9.2 CI 3.9,22) Conclusion Women attempting TOLAC with a macrosomic neonate are not at increased risk for failed TOLAC, operative vaginal delivery, uterine rupture, PPH, or OASI but are at risk of shoulder dystocia. This information helps counsel women considering TOLAC with a macrosomic fetus.

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“…Twenty of these studies were based on data from three US cohorts: a cohort in St. Louis, Missouri [29,30,42,45,61,64,66,78,79,84], the large multicenter Consortium on Safe Labor (CSL) cohort [14,34,41,52,55,58,66,83,91], and the National Collaborative Perinatal Project (CPP) cohort [92]; the CSL and CPP cohorts were compared in one study [53]. The thirteen largest studies were conducted with 50,000-150,000 participants and comprised a systematic review and meta-analysis including CSL cohort data [4], eight studies based solely on CSL data [14,34,41,52,55,66,83,91], a study in which the CSL and CPP cohorts were compared [53], two studies based on Israeli cohort data [43,47], and a study based on Swedish cohort data [59]. Most studies had smaller samples: 30 studies included <1000 women [7,27,31 [26,29,40,92].…”

Section: Plos Onementioning

confidence: 99%

“…Labor curve comparison was challenging due to the heterogeneity in definitions of antenatal risk factors, intrapartum risk factors and treatments, and adverse outcomes (S1 Table ). The curves were stratified by parity [4,14,[26][27][28][29][30][33][34][35]38,[43][44][45][46][47][49][50][51][52][53][54][55][56][57][58][59][60]62,64,65,67,69,71,72,74,76,80,81,[83][84][85][89][90][91][92]95], labor onset [29,41,45,…”

Section: Plos Onementioning

confidence: 99%

Labor curves based on cervical dilatation over time and their accuracy and effectiveness: A systematic scoping review

Huurnink,

Blix,

Hals

et al. 2024

PLoS ONE

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Objectives This systematic scoping review was conducted to 1) identify and describe labor curves that illustrate cervical dilatation over time; 2) map any evidence for, as well as outcomes used to evaluate the accuracy and effectiveness of the curves; and 3) identify areas in research that require further investigation. Methods A three-step systematic literature search was conducted for publications up to May 2023. We searched the Medline, Maternity & Infant Care, Embase, Cochrane Library, Epistemonikos, CINAHL, Scopus, and African Index Medicus databases for studies describing labor curves, assessing their effectiveness in improving birth outcomes, or assessing their accuracy as screening or diagnostic tools. Original research articles and systematic reviews were included. We excluded studies investigating adverse birth outcomes retrospectively, and those investigating the effect of analgesia-related interventions on labor progression. Study eligibility was assessed, and data were extracted from included studies using a piloted charting form. The findings are presented according to descriptive summaries created for the included studies. Results and implications for research Of 26,073 potentially eligible studies, 108 studies were included. Seventy-three studies described labor curves, of which ten of the thirteen largest were based mainly on the United States Consortium on Safe Labor cohort. Labor curve endpoints were 10 cm cervical dilatation in 69 studies and vaginal birth in 4 studies. Labor curve accuracy was assessed in 26 studies, of which all 15 published after 1986 were from low- and middle–income countries. Recent studies of labor curve accuracy in high-income countries are lacking. The effectiveness of labor curves was assessed in 13 studies, which failed to prove the superiority of any curve. Patient-reported health and well-being is an underrepresented outcome in evaluations of labor curves. The usefulness of labor curves is still a matter of debate, as studies have failed to prove their accuracy or effectiveness.

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Normal labor curve in twin gestation

Cited by 6 publications

References 15 publications

Partogram of Grandmultiparous Parturients: A Multicenter Cohort Study

Partogram of Grandmultiparous Parturients: A Multicenter Cohort Study

A Trial of Labor after Cesarean Section with a Macrosomic Neonate. Is It Safe?

Labor curves based on cervical dilatation over time and their accuracy and effectiveness: A systematic scoping review

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