Revisiting active phase of labor in primigravida with the help of E-partograph

Abstract

Background: Considering various geographical variations and the changing dynamics of medical health care provision, there is a need to revise the labor curve and find a geographical area, age and gestational age specific labor curve.

Methods: Observational study conducted in obstetrics and gynaecology department, M.G.M. Medical College, Indore, where all laboring primigravidas after applying inclusion criteria are monitored systematically with e-partogram for fetal heart sounds, uterine contractions, cervical dilatation and foetal head descent.

Result: Mean dilatation at adequate contraction is 5.8 cm means that active phase started from 5 to 6 cm of cervical dilatation onwards. The mean cervical dilatation rate in the active phase was 1.06 cm/hour with lowest acceptable rate of 0.44 cm/hour. Mean interval between adequate contraction and delivery (mean active phase duration) is 5.2 hours. At the statistical limits, the ‘active labor’ duration was 14 hours (mean + 2 SD) and the dilation rate was 0.44 cm/hour (mean − 2 SD).

Conclusion: Contrary to the generally held view, this study showed that nulliparous Indian women with spontaneous labor onset have longer ‘active’ labor duration and, slower dilation rates. If we follow Friedman’s labor norms, it could result in increased interventions. Hence, it would be sagacious to prepare a personalized labor curve for the local population served, based on their distinctive characteristics features together with shifting the definition of active phase onset to 6 cm could be beneficial in terms of unnecessary referral prevention, decreasing caesarean rates and increasing normal delivery rates.