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Observational Study
. 2024 Jul 3;19(7):e0305243.
doi: 10.1371/journal.pone.0305243. eCollection 2024.

Labor patterns of spontaneous first-stage labor in Chinese women with normal neonatal outcomes

Li Peng  1   2 , Zengyu Chen  1   3 , Shiyu Weng  2 , Jian Huang  2 , Mei Peng  2 , Yali Deng  2 , Ying Xu  4 , Fangfang Zhou  2 , Yamin Li  1
Affiliations
Observational Study

Labor patterns of spontaneous first-stage labor in Chinese women with normal neonatal outcomes

Li Peng et al. PLoS One. .

Abstract

Background: Friedman's standards, developed almost 50 years ago, may no longer align with the needs of today's obstetric population and current pregnancy management practices. This study aims to analyze contemporary labor patterns and estimate labor duration in China, focusing on first-stage labor data from Chinese parturients with a spontaneous onset of labor.

Methods: This retrospective observational study utilized data from electronic medical records of a tertiary hospital in Changsha, Hunan. Out of a total of 2,689 parturients, exclusions were made for multiple gestations, preterm, post-term, or stillbirth, cesarean delivery, non-vertex presentation, and neonatal intensive care unit admission. Average labor curves were constructed by parity using repeated-measure analysis, and labor duration was estimated through interval-censored regression, stratified by cervical dilation at admission. We performed an analysis to assess the impact of oxytocin augmentation and amniotomy on labor progression and conducted a sensitivity analysis using women with complicated outcomes.

Results: Nulliparous women take over 180 minutes for cervical dilation from 3 to 4 cm, and the duration from 5 to 6 cm exceeds 145 minutes. Multiparous women experience shorter labor durations than nulliparous. Labor acceleration is observed after 5 cm in nulliparous, but no distinct inflection point is evident in the average labor curve. In the second stage of labor, the 95th percentile for nulliparous, with and without epidural analgesia, is 142 minutes and 127 minutes, respectively.

Conclusions: These findings provide valuable insights for the reassessment of labor and delivery processes in contemporary obstetric populations, including current Chinese obstetric practice.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow diagram of the study selection process.
Fig 2
Fig 2. Average labor curves among study population by parity.
P0: nulliparous; P1+: multiparous.
Fig 3
Fig 3. The 95th centile of cumulative duration of labor from admission among singleton, term nulliparous with spontaneous onset of labor, vertex presentation, vaginal delivery, and normal neonatal outcomes.
See this image and copyright information in PMC

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