Abstract
Aim:
To assess fetal descent rates of nulliparous and multiparous women in the active phase of labor and to evaluate significant impact factors.
Methods:
In a retrospective cohort study at the University Hospital of Zurich, Switzerland, we evaluated 6045 spontaneous vaginal deliveries with a singleton in vertex presentation between January 2007 and July 2014 at 34 0/7 to 42 0/7 gestational weeks. Median fetal descent rates and their 10th and 90th percentiles were assessed in the active phase of labor and different impact factors were evaluated.
Results:
Fetal descent rates are exponentially increasing. Nulliparous women have slower fetal descent than multiparous women (P<0.001), ranging from 0 to 5.81 cm/h and from 0 to 15 cm/h, respectively. The total duration of fetal descent in labor is 5.42 h for nulliparous and 2.71 h for multiparous women. Accelerating impact factors are a lower fetal station, multiparity, increasing maternal weight and fetal occipitoanterior position, whereas epidural anesthesia decelerates fetal descent (P<0.001).
Conclusions:
Fetal descent is a hyperbolic increasing process with faster descent in multiparous women compared to nulliparous women, is highly inter individual and is associated with different impact factors. The diagnosis of labor arrest or prolonged labor should therefore be based on such rates as well as on individual evaluation of every parturient.
Author’s statement
Conflict of interest: The authors of this manuscript have no conflicts of interest to disclose as described by the Journal of Perinatal Medicine.
Material and methods: Informed consent: Informed consent has been obtained from all individuals included in this study.
Ethical approval: Approved by the Cantonal Ethical Committee of Zurich, Switzerland, under the registration number KEK-ZH-Nr. 2015-0105.
Contribution to authorship: NK: Study design, data management, statistical analysis, writing of the manuscript; JJ: Data management, statistical analysis; CH: Statistical analysis, revision of the manuscript; NO: Study design, revision of the manuscript; RZ: Study design, revision of the manuscript.
Funding: No funding was obtained for this study.
References
[1] American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine, Caughey AB, Cahill AG, Guise JM, Rouse DJ. Safe prevention of the primary cesarean delivery. Am J Obstet Gynecol. 2014;210:179–93.10.1016/j.ajog.2014.01.026Search in Google Scholar PubMed
[2] Friedman EA. Labor in multiparas; a graphicostatistical analysis. Obstet Gynecol. 1956;8:691–703.10.1097/00006250-195612000-00007Search in Google Scholar
[3] Friedman EA. Primigravid labor; a graphicostatistical analysis. Obstet Gynecol. 1955;6:567–89.10.1097/00006250-195512000-00001Search in Google Scholar PubMed
[4] Graseck A, Tuuli M, Roehl K, Odibo A, Macones G, Cahill A. Fetal descent in labor. Obstet Gynecol. 2014;123:521–6.10.1097/AOG.0000000000000131Search in Google Scholar PubMed
[5] Carlhall S, Kallen K, Blomberg M. Maternal body mass index and duration of labor. Eur J Obstet Gynecol Reprod Biol. 2013;171:49–53.10.1016/j.ejogrb.2013.08.021Search in Google Scholar PubMed
[6] Zhang J, Landy HJ, Branch DW, Burkman R, Haberman S, Gregory KD, et al. Contemporary patterns of spontaneous labor with normal neonatal outcomes. Obstet Gynecol. 2010;116:1281–7.10.1097/AOG.0b013e3181fdef6eSearch in Google Scholar PubMed PubMed Central
[7] Laughon SK, Berghella V, Reddy UM, Sundaram R, Lu Z, Hoffman MK. Neonatal and maternal outcomes with prolonged second stage of labor. Obstet Gynecol. 2014;124:57–67.10.1097/AOG.0000000000000278Search in Google Scholar PubMed PubMed Central
[8] Cheng YW, Caughey AB. Second stage of labor. Clin Obstet Gynecol. 2015;58:227–40.10.1097/GRF.0000000000000113Search in Google Scholar PubMed
[9] Spong CY, Berghella V, Wenstrom KD, Mercer BM, Saade GR. Preventing the first cesarean delivery: summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, and American College of Obstetricians and Gynecologists Workshop. Obstet Gynecol. 2012;120:1181–93.10.1097/AOG.0b013e3182704880Search in Google Scholar PubMed PubMed Central
[10] Zaki MN, Hibbard JU, Kominiarek MA. Contemporary labor patterns and maternal age. Obstet Gynecol. 2013;122:1018–24.10.1097/AOG.0b013e3182a9c92cSearch in Google Scholar PubMed PubMed Central
[11] Albers LL, Schiff M, Gorwoda JG. The length of active labor in normal pregnancies. Obstet Gynecol. 1996;87:355–9.10.1016/0029-7844(95)00423-8Search in Google Scholar
[12] Kilpatrick SJ, Laros RK Jr. Characteristics of normal labor. Obstet Gynecol. 1989;74:85–7.10.1097/00132582-199004000-00007Search in Google Scholar
[13] Vahratian A, Hoffman MK, Troendle JF, Zhang J. The impact of parity on course of labor in a contemporary population. Birth 2006;33:12–7.10.1111/j.0730-7659.2006.00069.xSearch in Google Scholar PubMed
[14] Leftwich HK, Gao W, Wilkins I. Does increase in birth weight change the normal labor curve? Am J Perinatol. 2015;32:87–92.10.1055/s-0034-1376180Search in Google Scholar PubMed
[15] Alexander JM, Sharma SK, McIntire DD, Leveno KJ. Epidural analgesia lengthens the Friedman active phase of labor. Obstet Gynecol. 2002;100:46–50.Search in Google Scholar
[16] Greenberg MB, Cheng YW, Hopkins LM, Stotland NE, Bryant AS, Caughey AB. Are there ethnic differences in the length of labor? Am J Obstet Gynecol. 2006;195:743–8.10.1016/j.ajog.2006.06.016Search in Google Scholar PubMed
[17] Schiessl B, Janni W, Jundt K, Rammel G, Peschers U, Kainer F. Obstetrical parameters influencing the duration of the second stage of labor. Eur J Obstet Gynecol Reprod Biol. 2005;118:17–20.10.1016/j.ejogrb.2004.01.045Search in Google Scholar PubMed
[18] Howell CJ. Epidural versus non-epidural analgesia for pain relief in labour. Cochrane Database Syst Rev. 2000:CD000331.10.1002/14651858.CD000331Search in Google Scholar PubMed
[19] American College of Obstetrics and Gynecology Committee on Practice B-O. ACOG Practice Bulletin Number 49, December 2003: dystocia and augmentation of labor. Obstet Gynecol. 2003;102:1445–54.10.1016/j.obstetgynecol.2003.10.011Search in Google Scholar PubMed
[20] Neilson JP, Lavender T, Quenby S, Wray S. Obstructed labour. Br Med Bull. 2003;67:191–204.10.1093/bmb/ldg018Search in Google Scholar PubMed
[21] Seval MM, Yuce T, Kalafat E, Duman B, Aker SS, Kumbasar H, et al. Comparison of digital vaginal examination versus transperineal ultrasound during labor on pain and anxiety levels: a randomized controlled trial. Ultrasound Obstet Gynecol. 2016;48:695–700.10.1002/uog.15994Search in Google Scholar PubMed
[22] Downe S, Gyte GM, Dahlen HG, Singata M. Routine vaginal examinations for assessing progress of labour to improve outcomes for women and babies at term. Cochrane Database Syst Rev. 2013:CD010088.10.1002/14651858.CD010088Search in Google Scholar
[23] Awan N, Rhoades A, Weeks AD. The validity and reliability of the StationMaster: a device to improve the accuracy of station assessment in labour. Eur J Obstet Gynecol Reprod Biol. 2009;145:65–70.10.1016/j.ejogrb.2009.04.018Search in Google Scholar
[24] Buchmann EJ, Libhaber E. Accuracy of cervical assessment in the active phase of labour. Br J Obstet Gynecol. 2007;114:833–7.10.1111/j.1471-0528.2007.01386.xSearch in Google Scholar
[25] DGGG GSoOaG. Tocolytics to prevent preterm birth. AWMF 1500252010.Search in Google Scholar
[26] Hanley GE, Munro S, Greyson D, Gross MM, Hundley V, Spiby H, et al. Diagnosing onset of labor: a systematic review of definitions in the research literature. BMC Pregnancy Childbirth. 2016;16:71.10.1186/s12884-016-0857-4Search in Google Scholar
[27] Gurewitsch ED, Johnson E, Allen RH, Diament P, Fong J, Weinstein D, et al. The descent curve of the grand multiparous woman. Am J Obstet Gynecol. 2003;189:1036–41.10.1067/S0002-9378(03)00762-2Search in Google Scholar
[28] Cheng YW, Shaffer BL, Nicholson JM, Caughey AB. Second stage of labor and epidural use: a larger effect than previously suggested. Obstet Gynecol. 2014;123:527–35.10.1097/AOG.0000000000000134Search in Google Scholar PubMed
[29] Kominiarek MA, Zhang J, Vanveldhuisen P, Troendle J, Beaver J, Hibbard JU. Contemporary labor patterns: the impact of maternal body mass index. Am J Obstet Gynecol. 2011;205:244 e1–8.10.1016/j.ajog.2011.06.014Search in Google Scholar PubMed PubMed Central
[30] Laughon SK, Branch DW, Beaver J, Zhang J. Changes in labor patterns over 50 years. Am J Obstet Gynecol. 2012;206:419 e1–9.10.1016/j.ajog.2012.03.003Search in Google Scholar PubMed PubMed Central
[31] Greenberg MB, Cheng YW, Sullivan M, Norton ME, Hopkins LM, Caughey AB. Does length of labor vary by maternal age? Am J Obstet Gynecol. 2007;197:428 e1–7.10.1016/j.ajog.2007.06.058Search in Google Scholar PubMed
[32] Albers LL. The duration of labor in healthy women. J Perinatol. 1999;19:114–9.10.1038/sj.jp.7200100Search in Google Scholar PubMed
[33] Anim-Somuah M, Smyth RM, Jones L. Epidural versus non-epidural or no analgesia in labour. Cochrane Database Syst Rev. 2011:CD000331.10.1002/14651858.CD000331.pub2Search in Google Scholar PubMed
[34] Molina FS, Nicolaides KH. Ultrasound in labor and delivery. Fetal Diagn Ther. 2010;27:61–7.10.1159/000287588Search in Google Scholar PubMed
[35] Bamberg C, Scheuermann S, Fotopoulou C, Slowinski T, Duckelmann AM, Teichgraber U, et al. Angle of progression measurements of fetal head at term: a systematic comparison between open magnetic resonance imaging and transperineal ultrasound. Am J Obstet Gynecol. 2012;206:161 e1–5.10.1016/j.ajog.2011.10.867Search in Google Scholar PubMed
[36] Ohel G, Gonen R, Vaida S, Barak S, Gaitini L. Early versus late initiation of epidural analgesia in labor: does it increase the risk of cesarean section? A randomized trial. Am J Obstet Gynecol. 2006;194:600–5.10.1016/j.ajog.2005.10.821Search in Google Scholar PubMed
[37] Gross MM, Fromke C, Hecker H. The timing of amniotomy, oxytocin and neuraxial analgesia and its association with labour duration and mode of birth. Arch Gynecol Obstet. 2014;289:41–8.10.1007/s00404-013-2916-7Search in Google Scholar PubMed
[38] Sng BL, Leong WL, Zeng Y, Siddiqui FJ, Assam PN, Lim Y, et al. Early versus late initiation of epidural analgesia for labour. Cochrane Database Syst Rev. 2014;10: CD007238.10.1002/14651858.CD007238.pub2Search in Google Scholar PubMed
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