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Spontaneous labor progression for vaginal births is slower than expected in many women

PLOS

Cervical dilatation during labour for vaginal births can progress more slowly than the widely accepted benchmark of 1 cm/hour in many women, according to a new data published this week in PLOS Medicine by Olufemi Oladapo, Medical Officer at WHO Department of Reproductive Health and Research including the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Switzerland, and colleagues.

As part of the World Health Organization's Better Outcomes in Labour Difficulty (BOLD) project, the authors examined the patterns of labour progression based on cervical dilatation over time in a cohort of 5,606 women in Nigeria and Uganda who gave birth vaginally, with no adverse birth outcomes, following onset of spontaneous labour. They found that median time to advance by 1 cm exceeded 1 hour until 5 cm was reached for women having their first child and women who had given birth previously. Furthermore, women giving birth to their first child and progressing at the slowest rates (95th percentile) may take up to 7 hours to progress from 4 to 5 cm, over 3 hours to progress from 5 to 6 cm, and up to 9 hours to progress from 6 to 10 cm.

The authors noted that as labour may not naturally accelerate in some women until a cervical dilatation of at least 5 cm, interventions to expedite labour before this dilatation is reached may be inappropriate, irrespective of whether or not the woman has given birth before.

The authors say: "Our labour progression data clearly demonstrate that a minimum cervical dilatation rate of 1 cm/hour throughout the period traditionally described as active phase may be unrealistically fast for some women and should therefore not be universally applied as a threshold for identifying abnormally progressing labour." They add that "Averaged labour curves may not truly reflect the variability associated with labour progression, and their use for decision-making in labour management should be de-emphasized."

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Research Article

Funding:

This work was funded by the Bill & Melinda Gates Foundation (Grant #OPP1084318: https://www.gatesfoundation.org/How-We-Work/Quick-Links/Grants-Database#q/k=OPP1084318); The United States Agency for International Development (USAID); and the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a cosponsored program executed by the World Health Organization (WHO). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests:

The authors have declared that no competing interests exist.

Citation:

Oladapo OT, Souza JP, Fawole B, Mugerwa K, Perdoná G, Alves D, et al. (2018) Progression of the first stage of spontaneous labour: A prospective cohort study in two sub-Saharan African countries. PLoS Med 15(1): e1002492. https://doi.org/10.1371/journal.pmed.1002492

Author Affiliations:

UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan, Nigeria
Department of Obstetrics and Gynaecology, Makerere University, Kampala, Uganda
Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
Institute of Mathematical Science and Computing, University of São Paulo, São Carlos, São Paulo, Brazil
Department of Obstetrics and Gynaecology, Mother and Child Hospital, Akure, Ondo State, Nigeria
Department of Obstetrics and Gynaecology, Maitama District Hospital, Abuja, FCT, Nigeria
Department of Obstetrics and Gynaecology, Mother and Child Hospital, Ondo, Ondo State, Nigeria
Department of Obstetrics and Gynaecology, Asokoro District Hospital, Abuja, FCT, Nigeria
Department of Obstetrics and Gynaecology, Nyanya General Hospital, Abuja, FCT, Nigeria
Department of Obstetrics and Gynaecology, Karshi General Hospital, Abuja, FCT, Nigeria
Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, United Kingdom
Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
SAMRC/UP Maternal and Infant Health Care Strategies Unit, University of Pretoria, Pretoria, South Africa
Jhpiego, an affiliate of Johns Hopkins University, Baltimore, Maryland, United States of America
Women's Health Research Unit, Queen Mary University of London, London, United Kingdom
United States Agency for International Development, Bureau for Global Health, Washington D.C., United States of America
Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
School of Nursing Midwifery & Social Work, University of Manchester, Manchester, United Kingdom
Bill & Melinda Gates Foundation, Seattle, Washington, United States of America
United Nations Population Fund, Geneva, Switzerland
Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
Liverpool School of Tropical Medicine, Liverpool, United Kingdom

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