Contemporary patterns of spontaneous labor with normal neonatal outcomes

Jun Zhang*, Helain J. Landy, D. Ware Branch, Ronald Burkman, Shoshana Haberman, Kimberly D. Gregory, Christos G. Hatjis, Mildred M. Ramirez, Jennifer L. Bailit, Victor H. Gonzalez-Quintero, Judith U. Hibbard, Matthew K. Hoffman, Michelle Kominiarek, Lee A. Learman, Paul Van Veldhuisen, James Troendle, Uma M. Reddy

*Corresponding author for this work

Research output: Contribution to journalArticle

306 Citations (Scopus)

Abstract

Objective: To use contemporary labor data to examine the labor patterns in a large, modern obstetric population in the United States. Methods: Data were from the Consortium on Safe Labor, a multicenter retrospective study that abstracted detailed labor and delivery information from electronic medical records in 19 hospitals across the United States. A total of 62,415 parturients were selected who had a singleton term gestation, spontaneous onset of labor, vertex presentation, vaginal delivery, and a normal perinatal outcome. A repeated-measures analysis was used to construct average labor curves by parity. An interval-censored regression was used to estimate duration of labor, stratified by cervical dilation at admission and centimeter by centimeter. Results: Labor may take more than 6 hours to progress from 4 to 5 cm and more than 3 hours to progress from 5 to 6 cm of dilation. Nulliparous and multiparous women appeared to progress at a similar pace before 6 cm. However, after 6 cm, labor accelerated much faster in multiparous than in nulliparous women. The 95 percentiles of the second stage of labor in nulliparous women with and without epidural analgesia were 3.6 and 2.8 hours, respectively. A partogram for nulliparous women is proposed. Conclusion: In a large, contemporary population, the rate of cervical dilation accelerated after 6 cm, and progress from 4 cm to 6 cm was far slower than previously described. Allowing labor to continue for a longer period before 6 cm of cervical dilation may reduce the rate of intrapartum and subsequent repeat cesarean deliveries in the United States.

Original languageEnglish (US)
Pages (from-to)1281-1287
Number of pages7
JournalObstetrics and gynecology
Volume116
Issue number6
DOIs
StatePublished - Dec 1 2010

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Dilatation
Labor Presentation
Second Labor Stage
Epidural Analgesia
Electronic Health Records
Parity
Population
Obstetrics
Multicenter Studies
Retrospective Studies
Parturition
Pregnancy

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Zhang, J., Landy, H. J., Ware Branch, D., Burkman, R., Haberman, S., Gregory, K. D., ... Reddy, U. M. (2010). Contemporary patterns of spontaneous labor with normal neonatal outcomes. Obstetrics and gynecology, 116(6), 1281-1287. https://doi.org/10.1097/AOG.0b013e3181fdef6e
Zhang, Jun ; Landy, Helain J. ; Ware Branch, D. ; Burkman, Ronald ; Haberman, Shoshana ; Gregory, Kimberly D. ; Hatjis, Christos G. ; Ramirez, Mildred M. ; Bailit, Jennifer L. ; Gonzalez-Quintero, Victor H. ; Hibbard, Judith U. ; Hoffman, Matthew K. ; Kominiarek, Michelle ; Learman, Lee A. ; Van Veldhuisen, Paul ; Troendle, James ; Reddy, Uma M. / Contemporary patterns of spontaneous labor with normal neonatal outcomes. In: Obstetrics and gynecology. 2010 ; Vol. 116, No. 6. pp. 1281-1287.
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Zhang, J, Landy, HJ, Ware Branch, D, Burkman, R, Haberman, S, Gregory, KD, Hatjis, CG, Ramirez, MM, Bailit, JL, Gonzalez-Quintero, VH, Hibbard, JU, Hoffman, MK, Kominiarek, M, Learman, LA, Van Veldhuisen, P, Troendle, J & Reddy, UM 2010, 'Contemporary patterns of spontaneous labor with normal neonatal outcomes', Obstetrics and gynecology, vol. 116, no. 6, pp. 1281-1287. https://doi.org/10.1097/AOG.0b013e3181fdef6e

Contemporary patterns of spontaneous labor with normal neonatal outcomes. / Zhang, Jun; Landy, Helain J.; Ware Branch, D.; Burkman, Ronald; Haberman, Shoshana; Gregory, Kimberly D.; Hatjis, Christos G.; Ramirez, Mildred M.; Bailit, Jennifer L.; Gonzalez-Quintero, Victor H.; Hibbard, Judith U.; Hoffman, Matthew K.; Kominiarek, Michelle; Learman, Lee A.; Van Veldhuisen, Paul; Troendle, James; Reddy, Uma M.

In: Obstetrics and gynecology, Vol. 116, No. 6, 01.12.2010, p. 1281-1287.

Research output: Contribution to journalArticle

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AU - Zhang, Jun

AU - Landy, Helain J.

AU - Ware Branch, D.

AU - Burkman, Ronald

AU - Haberman, Shoshana

AU - Gregory, Kimberly D.

AU - Hatjis, Christos G.

AU - Ramirez, Mildred M.

AU - Bailit, Jennifer L.

AU - Gonzalez-Quintero, Victor H.

AU - Hibbard, Judith U.

AU - Hoffman, Matthew K.

AU - Kominiarek, Michelle

AU - Learman, Lee A.

AU - Van Veldhuisen, Paul

AU - Troendle, James

AU - Reddy, Uma M.

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N2 - Objective: To use contemporary labor data to examine the labor patterns in a large, modern obstetric population in the United States. Methods: Data were from the Consortium on Safe Labor, a multicenter retrospective study that abstracted detailed labor and delivery information from electronic medical records in 19 hospitals across the United States. A total of 62,415 parturients were selected who had a singleton term gestation, spontaneous onset of labor, vertex presentation, vaginal delivery, and a normal perinatal outcome. A repeated-measures analysis was used to construct average labor curves by parity. An interval-censored regression was used to estimate duration of labor, stratified by cervical dilation at admission and centimeter by centimeter. Results: Labor may take more than 6 hours to progress from 4 to 5 cm and more than 3 hours to progress from 5 to 6 cm of dilation. Nulliparous and multiparous women appeared to progress at a similar pace before 6 cm. However, after 6 cm, labor accelerated much faster in multiparous than in nulliparous women. The 95 percentiles of the second stage of labor in nulliparous women with and without epidural analgesia were 3.6 and 2.8 hours, respectively. A partogram for nulliparous women is proposed. Conclusion: In a large, contemporary population, the rate of cervical dilation accelerated after 6 cm, and progress from 4 cm to 6 cm was far slower than previously described. Allowing labor to continue for a longer period before 6 cm of cervical dilation may reduce the rate of intrapartum and subsequent repeat cesarean deliveries in the United States.

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Zhang J, Landy HJ, Ware Branch D, Burkman R, Haberman S, Gregory KD et al. Contemporary patterns of spontaneous labor with normal neonatal outcomes. Obstetrics and gynecology. 2010 Dec 1;116(6):1281-1287. https://doi.org/10.1097/AOG.0b013e3181fdef6e