دورية أكاديمية
أعرض في EDS

The duration of spontaneous active and pushing phases of labour among 75,243 US women when intervention is minimal: A prospective, observational cohort study.

التفاصيل البيبلوغرافية
العنوان: The duration of spontaneous active and pushing phases of labour among 75,243 US women when intervention is minimal: A prospective, observational cohort study.
المؤلفون: Tilden EL; Department Nurse-Midwifery, School of Nursing, Oregon Health and Science University , 577, 3181 SW Sam Jackson Park Rd., Portland, OR 97214, USA.; UpLift Lab, Oregon State University, Corvallis, OR, USA.; Department of Obstetrics and Gynecology, School of Medicine, Oregon Health and Science University, Portland, OR, USA., Snowden JM; UpLift Lab, Oregon State University, Corvallis, OR, USA.; Oregon Health and Science University/Portland State University School of Public Health, Portland, OR, USA., Bovbjerg ML; UpLift Lab, Oregon State University, Corvallis, OR, USA.; College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA., Cheyney M; UpLift Lab, Oregon State University, Corvallis, OR, USA.; Department of Anthropology, Oregon State University, Corvallis, OR, USA., Lapidus J; Oregon Health and Science University/Portland State University School of Public Health, Portland, OR, USA.; Oregon Health and Science University Biostatistics and Design Program, Portland, OR, USA., Wiedrick J; Oregon Health and Science University/Portland State University School of Public Health, Portland, OR, USA.; Oregon Health and Science University Biostatistics and Design Program, Portland, OR, USA., Caughey AB; Department Nurse-Midwifery, School of Nursing, Oregon Health and Science University , 577, 3181 SW Sam Jackson Park Rd., Portland, OR 97214, USA.; Department of Obstetrics and Gynecology, School of Medicine, Oregon Health and Science University, Portland, OR, USA.
المصدر: EClinicalMedicine [EClinicalMedicine] 2022 May 22; Vol. 48, pp. 101447. Date of Electronic Publication: 2022 May 22 (Print Publication: 2022).
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: The Lancet Country of Publication: England NLM ID: 101733727 Publication Model: eCollection Cited Medium: Internet ISSN: 2589-5370 (Electronic) Linking ISSN: 25895370 NLM ISO Abbreviation: EClinicalMedicine Subsets: PubMed not MEDLINE
أسماء مطبوعة: Original Publication: [London] : The Lancet, [2018]-
مستخلص: Background: Friedman's curve, despite acknowledged limitations, has greatly influenced labour management. Interventions to hasten birth are now ubiquitous, challenging the contemporary study of normal labour. Our primary purpose was to characterise normal active labour and pushing durations in a large, contemporary sample experiencing minimal intervention, stratified by parity, age, and body mass index (BMI).
Methods: This is a secondary analysis of the national, validated Midwives Alliance of North America 4·0 (MANA Stats) data registry ( n  = 75,243), prospectively collected between Jan 1, 2012 and Dec 31, 2018 to describe labour and birth in home and birth center settings where common obstetric interventions [i.e., oxytocin, planned cesarean] are not available. The MANA Stats cohort includes pregnant people who intended birth in these settings and prospectively collects labour and birth processes and outcomes regardless of where birth or postpartum care ultimately occurs. Survival curves were calculated to estimate labour duration percentiles (e.g. 10th, 50th, 90th, and others of interest), by parity and sub-stratified by age and BMI.
Findings: Compared to multiparous women ( n  = 32,882), nulliparous women ( n  = 15,331) had significantly longer active labour [e.g., median 7.5 vs. 3.3 h; 95th percentile 34.8 vs. 12.0 h] and significantly longer pushing phase [e.g., median 1.1 vs. 0.2 h; 95th percentile 5.5 vs. 1.1 h]. Among nulliparous women, maternal age >35 was associated with longer active first stage of labour and longer pushing phase, and BMI >30 kg/m² was associated with a longer active first stage of labour but a shorter pushing phase. Patterns among multiparous women were different, with those >35 years of age experiencing a slightly more rapid active labour and no difference in pushing duration, and those with BMI >30 kg/m² experiencing a slightly longer active labour but, similarly, no difference in pushing duration.
Interpretation: Nulliparous women had significantly longer active first stage and pushing phase durations than multiparous women, with further variation noted by age and by BMI. Contemporary US women with low-risk pregnancies who intended birth in settings absent common obstetric interventions and in spontaneous labour with a live, vertex, term, singleton, non-anomalous fetus experienced labour durations that were often longer than prior characterizations, particularly among nulliparous women. Results overcome prior and current sampling limitations to refine understanding of normal labour durations and time thresholds signaling 'labour dystocia'.
Funding: OHSU Nursing Innovation and OHSU University Shared Resources.
Competing Interests: ET declares the following interests: Co-Owner and Chief Scientific Officer for CenterMom, Inc. She has stock ownership in this company. Consultant and Director of Maternity Care for Stork Club, Inc. She receives payment for her work with Stork Club. JS, MC, MB, JL, JW, and AC have nothing to disclose.
(© 2022 The Author(s).)
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فهرسة مساهمة: Keywords: Labour duration; Labour dystocia; Labour progress; Prolonged labour
تواريخ الأحداث: Date Created: 20220705 Latest Revision: 20220716
رمز التحديث: 20240628
مُعرف محوري في PubMed: PMC9249551
DOI: 10.1016/j.eclinm.2022.101447
PMID: 35783483
قاعدة البيانات: MEDLINE
الوصف
تدمد:2589-5370
DOI:10.1016/j.eclinm.2022.101447