Refining the clinical definition of active phase arrest of dilation in nulliparous women to consider degree of cervical dilation as well as duration of arrest.: Short title: Clinically defined active phase arrest of labor.

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Citation: American Journal of Obstetrics & Gynecology. 225(3):294.e1-294.e14, 2021 09.PMID: 33798479Institution: MedStar Health Research Institute | MedStar Washington Hospital CenterDepartment: Maternal-Fetal Medicine Fellowship | Obstetrics and Gynecology/Maternal-Fetal MedicineForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Labor Stage, First | *Obstetric Labor Complications | *Parity | Adult | Cesarean Section/sn [Statistics & Numerical Data] | Chorioamnionitis/ep [Epidemiology] | Cohort Studies | Female | Humans | Pregnancy | Retrospective Studies | Time FactorsYear: 2021ISSN:
  • 0002-9378
Name of journal: American journal of obstetrics and gynecologyAbstract: BACKGROUND: Maternal and neonatal outcomes associated with duration of arrest of dilation beyond 4 hours are not well known. In addition, the current definition of arrest does not consider the degree of cervical dilation (6 cm vs. 7 cm vs. 8 cm vs. 9 cm) when arrest occurs.CONCLUSION: When cervical dilation is 6 or 7 cm, allowing arrest of dilation 4 hours or longer is reasonable since it was not associated with increased risks of adverse neonatal outcomes. When cervical dilation is 8 or 9 cm, the benefit of allowing arrest of dilation 4 hours or longer should be balanced against the risk of adverse maternal and neonatal outcomes. Copyright (c) 2021. Published by Elsevier Inc.OBJECTIVE: We sought to examine maternal and neonatal outcomes in nulliparous women who achieved the active phase of labor according to the duration they required to achieve at least 1 cm of cervical change (less than 4 hours vs. 4-5.9 hours vs 6 hours or greater) beginning at 6, 7, 8 and 9 cm.RESULTS: Of 31,505 nulliparous women included in this study, 13,142 (42%), 10,855 (34%), 11,761 (37%), and 17,049 (54%) reached documented cervical dilation of 6, 7, 8, and 9 cm, respectively. At cervical dilation of 6 or 7 cm, arrest of dilation less than 4 hours compared to 4-5.9 hours was associated with decreased risks of adverse maternal outcomes. When cervical dilation was 8 or 9 cm, arrest of dilation less than 4 hours compared to 4-5.9 hours was associated with decreased risks of adverse maternal and neonatal outcomes. For example, women starting at 8 cm cervical dilation who required less than 4 hours to achieve 1 cm of cervical change compared to those who required 4-5.9 hours had lower rates of cesarean delivery (aOR 0.40; 95%CI 0.28-0.55), chorioamnionitis (aOR 0.42; 95%CI 0.29-0.60), and the neonatal composite outcome (aOR 0.51; 95%CI 0.36-0.72).STUDY DESIGN: This was a retrospective cohort study of nulliparous women with term singleton cephalic pregnancies in spontaneous or induced active labor (6 cm or greater). To evaluate the effect of labor duration on maternal and fetal outcomes at different degrees of cervical dilation, we categorized women based on time intervals they required to achieve at least 1 cm of cervical change after membrane rupture ("less than 4 hours," "4-5.9 hours," and "6 hours or greater"), and we correlated each time interval with referent cervical dilation status (6 cm, 7 cm, 8 cm and 9 cm). Maternal and neonatal outcomes were analyzed according to the duration to progress at least 1 cm starting from each degree of cervical dilation. Our primary outcome was a composite of neonatal outcomes, including intensive care unit admission, neonatal death, seizure, ventilator use, birth injury, and neonatal asphyxia. We also examined maternal outcomes. Adjusted odds ratios (aORs) with 95% confidence intervals (95%CIs) were calculated, controlling for predefined covariates.All authors: Gold SL, Huang JC, Iqbal SN, Kawakita TOriginally published: American Journal of Obstetrics & Gynecology. 2021 Mar 30Fiscal year: FY2022Fiscal year of original publication: FY2021Digital Object Identifier: Date added to catalog: 2021-06-07
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Journal Article MedStar Authors Catalog Article 33798479 Available 33798479

BACKGROUND: Maternal and neonatal outcomes associated with duration of arrest of dilation beyond 4 hours are not well known. In addition, the current definition of arrest does not consider the degree of cervical dilation (6 cm vs. 7 cm vs. 8 cm vs. 9 cm) when arrest occurs.

CONCLUSION: When cervical dilation is 6 or 7 cm, allowing arrest of dilation 4 hours or longer is reasonable since it was not associated with increased risks of adverse neonatal outcomes. When cervical dilation is 8 or 9 cm, the benefit of allowing arrest of dilation 4 hours or longer should be balanced against the risk of adverse maternal and neonatal outcomes. Copyright (c) 2021. Published by Elsevier Inc.

OBJECTIVE: We sought to examine maternal and neonatal outcomes in nulliparous women who achieved the active phase of labor according to the duration they required to achieve at least 1 cm of cervical change (less than 4 hours vs. 4-5.9 hours vs 6 hours or greater) beginning at 6, 7, 8 and 9 cm.

RESULTS: Of 31,505 nulliparous women included in this study, 13,142 (42%), 10,855 (34%), 11,761 (37%), and 17,049 (54%) reached documented cervical dilation of 6, 7, 8, and 9 cm, respectively. At cervical dilation of 6 or 7 cm, arrest of dilation less than 4 hours compared to 4-5.9 hours was associated with decreased risks of adverse maternal outcomes. When cervical dilation was 8 or 9 cm, arrest of dilation less than 4 hours compared to 4-5.9 hours was associated with decreased risks of adverse maternal and neonatal outcomes. For example, women starting at 8 cm cervical dilation who required less than 4 hours to achieve 1 cm of cervical change compared to those who required 4-5.9 hours had lower rates of cesarean delivery (aOR 0.40; 95%CI 0.28-0.55), chorioamnionitis (aOR 0.42; 95%CI 0.29-0.60), and the neonatal composite outcome (aOR 0.51; 95%CI 0.36-0.72).

STUDY DESIGN: This was a retrospective cohort study of nulliparous women with term singleton cephalic pregnancies in spontaneous or induced active labor (6 cm or greater). To evaluate the effect of labor duration on maternal and fetal outcomes at different degrees of cervical dilation, we categorized women based on time intervals they required to achieve at least 1 cm of cervical change after membrane rupture ("less than 4 hours," "4-5.9 hours," and "6 hours or greater"), and we correlated each time interval with referent cervical dilation status (6 cm, 7 cm, 8 cm and 9 cm). Maternal and neonatal outcomes were analyzed according to the duration to progress at least 1 cm starting from each degree of cervical dilation. Our primary outcome was a composite of neonatal outcomes, including intensive care unit admission, neonatal death, seizure, ventilator use, birth injury, and neonatal asphyxia. We also examined maternal outcomes. Adjusted odds ratios (aORs) with 95% confidence intervals (95%CIs) were calculated, controlling for predefined covariates.

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