Prediction of Duration of Active Labor in Nulliparous Women at Term

Incerti, Maddalena; Locatelli, Anna; Ghidini, Alessandro; Ciriello, Elena; Malberti, Silvia; Consonni, Sara; Pezzullo, John C.

doi:10.1055/s-2007-1004827

Cited by 14 publications

(21 citation statements)

References 22 publications

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“…However, a high proportion of the sample received epidurals and/or induction with oxytocin, and the researchers made no attempt to adjust for these factors. Incerti et al found an association between gestational age and duration of active labor in nulliparous women at term but did not analyze birthweight [15]. We found evidence of collinearity between birthweight and gestational age, suggesting that the effect of gestational age is at least partially mediated by birthweight.…”

Section: Discussioncontrasting

confidence: 51%

“…Although we have no way to offer proof, it is reasonable to assume that this relationship has more to do with the reasons or characteristics that led to oxytocin use, rather than its effects. Epidurals were also associated with longer conditional time, which can be related both to the indications for its use and to a negative effect on speed of labor [15, 17]. …”

Section: Discussionmentioning

confidence: 99%

“…The driving force behind this study was our interest in predicting time to completion of active labor and beginning of the second stage with pushing and imminent birth. The aim is not new, but the application of statistical models with complex functions might have the potential to improve prediction accuracy [15, 40]. However, some consider population-based average labor curves to be poor predictors for the individual progress of cervical dilation [30].…”

Section: Discussionmentioning

confidence: 99%

“…Average labor curves and tables showing median traverse time in centimeter integers can help diagnose abnormally slow labor progression but are not designed to estimate time to completion of cervical dilation conditional on the cervical opening and other factors known to be associated with the length of labor, including maternal age [12], height [13], body mass index (BMI) [14], parity [8], gestational age [15], and birthweight [6]. As well, timing of admission to the delivery unit [16], epidural analgesia [15, 17], and oxytocin use [18] are known to be associated with length of labor. Clinical protocol with early amniotomy and early oxytocin [19]–but not amniotomy alone [20]–is associated with slightly shorter time from admission to delivery.…”

Section: Introductionmentioning

confidence: 99%

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On predicting time to completion for the first stage of spontaneous labor at term in multiparous women

Gunnarsson

Skogvoll

Jónsdóttir

et al. 2017

BMC Pregnancy Childbirth

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BackgroundLabor that progresses faster than anticipated may lead to unplanned out-of-hospital births. With the aim to improve planning of transportation to birthing institutions, this study investigated predictors of time to completion for the first stage of labor conditional on cervical opening (conditional time) in multiparous women at term.MethodsWe performed a retrospective analysis of partograms for women in Robson’s group 3 who delivered at one hospital from 2003 to 2013. A generalized additive mixed model was fitted, accounting for possible non-linear relationships between the predictor variables and outcome, e.g. the time from each cervical measurement to full dilation, using multiple measurements for each woman. The following predictors were included: cervical dilation (cm), parity (1, 2, or ≥3 previous vaginal births), oxytocin infusion (no/yes), epidural (no/yes), maternal age (years), maternal height (cm), body mass index (BMI, kg/m2), birthweight (kg), spontaneous rupture of membranes (no/yes). A modified regression model with gestational age (days) instead of birthweight was used to predict conditional time to full cervical dilation for combinations of the most relevant predictors.ResultsA total of 1753 partograms were included in the analysis. The strongest predictors were birthweight, epidural and oxytocin use, and spontaneous rupture of membranes, along with cervical measurements. For birthweight, there was an almost 40% increase in time to full cervical dilation for each 1-kg increment. Conditional time was on average 23% longer in cases with epidural use and 53% longer in cases requiring oxytocin augmentation. Spontaneous rupture of the membranes shortened conditional time by 31%. Maternal age was not associated with the outcome, while increasing BMI and parity modestly reduced conditional time.ConclusionsHigher parity, lower fetal weight (gestational age), and spontaneous rupture of the membranes are associated with more rapid labor.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-017-1345-1) contains supplementary material, which is available to authorized users.

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Section: Discussioncontrasting

confidence: 51%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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On predicting time to completion for the first stage of spontaneous labor at term in multiparous women

Gunnarsson

Skogvoll

Jónsdóttir

et al. 2017

BMC Pregnancy Childbirth

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“…Incerti et al . reported on 1067 nulliparous women and found that a similar degree of variance ( R 2 = 0.51) in the length of labor could be determined with gestational age, maternal ethnicity, maternal risk factors, cervical dilatation, oxytocin use and epidural use as predictors in their model. Nesheim analyzed 5418 women in labor to assess the contribution of a variety of factors in predicting duration of labor, and found that the most significant predictors were nulliparity, induction vs spontaneous labor, neonatal birth weight, maternal height, gestational age and occipital position, but did not report overall variance.…”

Section: Discussionmentioning

confidence: 99%

Comparison of different methods of measuring angle of progression in prediction of labor outcome

Frick

Kostiv

Vojtassakova

et al. 2020

Ultrasound in Obstet & Gyne

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Objectives First, to compare the manual sagittal and parasagittal and automated parasagittal methods of measuring the angle of progression (AoP) by transperineal ultrasound during labor, and, second, to develop models for the prediction of time to delivery and need for Cesarean section (CS) for failure to progress (FTP) in a population of patients undergoing induction of labor. Methods This was a prospective observational study of transperineal ultrasound in a cohort of 512 women with a singleton pregnancy undergoing induction of labor. A random selection of 50 stored images was assessed for inter‐ and intraobserver reliability of AoP measurements using the manual sagittal and parasagittal and automated parasagittal methods. In cases of vaginal delivery, univariate linear, multiple linear and quantile regression analyses were performed to predict time to delivery. Univariate and multivariate binomial logistic regression analyses were performed to predict CS for FTP in the first stage of labor. Results The intraclass correlation coefficient (ICC) for the manual parasagittal method for a single observer was 0.97 (95% CI, 0.95–0.98) and for two observers it was 0.96 (95% CI, 0.93–0.98), indicating good reliability. The ICC for the sagittal method for a single observer was 0.93 (95% CI, 0.88–0.96) and for two observers it was 0.74 (95% CI, 0.58–0.84), indicating moderate reliability for a single observer and poor reliability between two observers. Bland–Altman analysis demonstrated narrower limits of agreement for the manual parasagittal approach than for the sagittal approach for both a single and two observers. The automated parasagittal method failed to capture an image in 19% of cases. The mean difference in AoP measurements between the sagittal and manual parasagittal methods was 11°. In pregnancies resulting in vaginal delivery, 54% of the variation in time to delivery was explained in a model combining parity, epidural and syntocinon use during labor and the sonographic findings of fetal head position and AoP. In the prediction of CS for FTP in the first stage of labor, a model which combined maternal factors with the sonographic measurements of AoP and estimated fetal weight was superior to one utilizing maternal factors alone (area under the receiver‐operating‐characteristics curve, 0.80 vs 0.76). Conclusions First, the method of measuring AoP with the greatest reliability is the manual parasagittal technique and future research should focus on this technique. Second, over half of the variation in time to vaginal delivery can be explained by a model that combines maternal factors, pregnancy characteristics and ultrasound findings. Third, the ability of AoP to provide clinically useful prediction of CS for FTP in the first stage of labor is limited. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

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Effect of gravity on volume of placental transfusion: a multicentre, randomised, non-inferiority trial

et al. 2014

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Prediction of Duration of Active Labor in Nulliparous Women at Term

Cited by 14 publications

References 22 publications

On predicting time to completion for the first stage of spontaneous labor at term in multiparous women

On predicting time to completion for the first stage of spontaneous labor at term in multiparous women

Comparison of different methods of measuring angle of progression in prediction of labor outcome

Effect of gravity on volume of placental transfusion: a multicentre, randomised, non-inferiority trial

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