Progression of the first stage of spontaneous labour: A prospective cohort study in two sub- Saharan African countries

Journal Article
(Published January, 2018)
Oladapo, O. (Author),
Souza, J.P. (Author),
Fawole, B. (Author),
Mugerwa, K. (Author),
Perdona, G. (Author),
Sanghvi, H. (Author)
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Escalation in the global rates of labour interventions, particularly cesarean section and oxytocin augmentation, has renewed interest in a better understanding of natural labour progression. Methodological advancements in statistical and computational techniques addressing the limitations of pioneer studies have led to novel findings and triggered a re-evaluation of current labour practices. As part of the World Health Organization's Better Outcomes in Labour Difficulty (BOLD) project, which aimed to develop a new labour monitoring-to-action tool, we examined the patterns of labour progression as depicted by cervical dilatation over time in a cohort of women in Nigeria and Uganda who gave birth vaginally following a spontaneous labour onset. Conclusions: Cervical dilatation during labour in the slowest-yet-normal women can progress more slowly than the widely accepted benchmark of 1 cm/hour, irrespective of parity. Interventions to expedite labour to conform to a cervical dilatation threshold of 1 cm/hour may be inappropriate, especially when applied before 5 cm in nulliparous and multiparous women. 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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Oladapo O, Souza J, Fawole B, K M, Perdona ÂG, Alves D, Sanghvi, H., et al. Progression of the first stage of spontaneous labour labour: A prospective cohort study in two sub-Saharan African countries. PLoS medicine. 2018