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Am J Perinatol 2018; 35(12): 1186-1191
DOI: 10.1055/s-0038-1642045
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Duration of Spontaneous Active Labor and Perinatal Outcomes Using Contemporary Labor Curves

Kara K. Hoppe
1   Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
2   Department of Obstetrics and Gynecology, School of Medicine, University of Washington, Seattle, Washington
,
Melissa A. Schiff
2   Department of Obstetrics and Gynecology, School of Medicine, University of Washington, Seattle, Washington
3   Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
,
Thomas J. Benedetti
2   Department of Obstetrics and Gynecology, School of Medicine, University of Washington, Seattle, Washington
,
Shani Delaney
2   Department of Obstetrics and Gynecology, School of Medicine, University of Washington, Seattle, Washington
› Author Affiliations
Funding Intramural funding was provided by University of Washington's Department of Obstetrics & Gynecology.
Further Information

Publication History

12 October 2017

15 March 2018

Publication Date:
25 April 2018 (online)

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Abstract

Objective Evaluate the association between spontaneous active labor duration utilizing contemporary labor curves and risk of adverse outcomes.

Materials and Methods This is a retrospective cohort study from January 2012 to January 2015. Subjects were nulliparous, 18 to 44 years, with a cephalic, singleton ≥37 weeks in spontaneous labor. Subjects were placed into three subgroups, defined by active labor duration from 6 to 10 cm as less than the median, the median-95th, and >95th percentile based on contemporary labor curves published by Zhang et al. We evaluated the association between subgroups and cesarean delivery, chorioamnionitis, estimated blood loss, Apgar score < 7 at 5 minutes, and neonatal intensive care unit admission using logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI).

Results Six-hundred forty two women met the inclusion criteria. Compared with women whose active labor was less than the median, the risk of cesarean was higher in the median-95th percentile ([adjusted OR, aOR] 3.1, 95% CI 1.8–5.5) and the >95th percentile ([aOR] 6.8, 95% CI 3.9–11.7) subgroups. There was an increased odds of chorioamnionitis in the median-95th percentile subgroup ([aOR] 2.5, 95% CI 1.1–5.9).

Conclusion Chorioamnionitis and cesarean delivery increased significantly as labor duration exceeded the median. This study provides a better understanding regarding the potential risk of cesarean and chorioamnionitis using contemporary labor curves.

Keywords

spontaneous labor - active labor duration - adverse perinatal outcomes - cesarean delivery - chorioamnionitis

Note

This manuscript was presented at the Society for Maternal-Fetal Medicine Annual Meeting. Atlanta, Georgia. 2016.