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Chapter 10 - Labor

from Part II - INTRAPARTUM AND POSTPARTUM

Published online by Cambridge University Press:  07 May 2010

John Patrick O'Grady ,
Martin L. Gimovsky ,
Lucy A. Bayer-Zwirello  and
Kevin Giordano
John Patrick O'Grady
Affiliation:
Tufts University, Massachusetts
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Summary

Obstetric labor management begins when the woman is first admitted. Many obstetricians or midwives are comfortable using ultrasound in the labor and delivery suite to verify the clinical examination. In the active phase of labor, the rate of progress in terms of cervical dilatation is a function of parity. This chapter discusses active management of labor. Progress in labor is commonly evaluated by plotting cervical dilatation and the descent of the presenting part against time. If marked cranial deflection is accompanied by abnormal labor progression, disproportion is likely, and cesarean delivery is normally the best management choice. Lesser degrees of deflection are common in many ultimately successful labors, especially in posterior and transverse presentations. Appropriate management protocols for oxytocin and epidural anesthetic use, makes it possible to provide adequate analgesia for a large percentage of labors and permit nearly normal labor progression with a low level of intervention.

Keywords

abnormal labor progressionactive management of laboranalgesianormal labor progressionoxytocincervical dilatationcesarean delivery
Type
Chapter
Information
Operative Obstetrics , pp. 232 - 256
Publisher: Cambridge University Press
Print publication year: 2008

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References

Hannah, ME, Ohlsson, A, Farine, D, Hewson, SA, Hodnett, ED, Myhr, TL, Wang, EE, Weston, JA, Willan, AR: Induction of labor compared with expectant management for prelabor rupture of membranes at term: The Term PROM study group. N Engl J Med 1996 Apr;334(16):1005–1010.CrossRefGoogle Scholar
O'Driscoll, K, Meagher, D, Boylan, P: Active management of labor. Aylesbury, England: Mosby Year Book Europe, Ltd., 1993.Google Scholar
Eltzschig, HK, Lieberman, ES, Camann, WR: Medical Progress: Regional anesthesia and analgesia for labor and delivery. N Engl J Med 2003 Jan;348(4):319–332.CrossRefGoogle Scholar
Wong, CA, Scavone, BM, Peaceman, AM, McCarthy, RJ, Sullivan, JT, Diaz, NT, Yaghmour, E, Marcus, RJ, Sherwani, SS, Sproviero, MT, Yilmaz, M, Patel, R, Robles, C, Grouper, S: The risk of cesarean delivery with neuraxial analgesia given early versus late in labor. N Engl J Med 2005 Feb;352(7):655–365.CrossRefGoogle Scholar
Lee, BB, Kee, Ngan WD, Lau, WM, Wong, AS: Epidural infusions for labor analgesia: A comparison of 0.2% ropivacaine and 0.1% ropivacaine with fentanyl. Reg Anesth Pain Med 2002 Jan–Feb;27(1):31–36.Google Scholar
Paech, MJ, Pavy, TJ, Sims, C, Westmore, MD, Storey, JM, White, C: Clinical experience with patient-controlled and staff-administered intermittent bolus epidural anesthesia in labour. Anaesth Intensive Care 1995 Aug;23(4):459–463.Google Scholar
Halpern, SH, Leighton, BL, Ohlsson, A, Barrett, JF, Rice, A: Effect of epidural vs. parenteral opioid analgesia on the progress of labor: A meta-analysis. JAMA 1998 Dec;280(24):2105–2110.CrossRefGoogle Scholar
Peisner, DB, Rosen, MG: Latent phase of labor in normal patients: A reassessment. Obstet Gynecol 1985 Nov;66(5):644–648.Google Scholar
Peisner, DB, Rosen, MG: Transition from latent to active labor. Obstet Gynecol 1985 Oct;68(4):448–451.Google Scholar
Zhang, J, Troendle, JF: Reassessing the labor curve in nulliparous women. Am J Obstet Gynecol 2002 Oct;187(4):824–828.CrossRefGoogle Scholar
Lavender, T, Alfirevic, Z, Walkinshaw, S: Effect of different partogram action lines on birth outcomes: A randomized controlled trial. Obstet Gynecol. 2006 Aug;108(2):295–302.CrossRefGoogle Scholar
Gurewitsch, ED, Diament, P, Fong, J, Huang, GH, Popovtzer, A, Weinstein, D, Chervenak, FA: The labor curve of the grand multipara: Does progress of labor continue to improve with additional childbearing?Am J Obstet Gynecol 2002 June;186(6):1331–1338.CrossRefGoogle Scholar
Friedman, EA: Labor: Clinical Evaluation and Management, 2nd ed. New York: Appleton-Century-Crofts, 1978.Google Scholar
Norwitz, ER, Robinson, JN: Current concepts of labor. N Engl J Med 1999;341:660–666.CrossRefGoogle Scholar
Mancuso, PJ, Alexander, JM, McIntire, DD, Davis, E, Burke, G, Leveno, KJ: Timing of birth after spontaneous onset of labor. Obstet Gynecol 2004 Apr; 103(4):653–656.CrossRefGoogle Scholar
American College of Obstetricians and Gynecologists. Committee on Obstetrics: Maternal and Fetal Medicine: Obstetric forceps. Technical Bulletin No. 59. Washington, DC: American College of Obstetricians and Gynecologists, 1988.
O'Grady, JP: Modern Instrumental Delivery. Baltimore: Williams & Wilkins, 1988.Google Scholar
Alexander, JM, Sharma, SK, McIntire, DD, Leveno, KJ: Epidural analgesia lengthens the Friedman active phase of labor. Obstet Gynecol 2002 Jul;100(1):46–50.Google Scholar
Dupuis, O, Silveira, R, Zentner, A, Dittmar, A, Gaucherand, P, Cucherat, M, Redarce, T, Rudigoz, RC: Birth simulator: Reliability of transvaginal assessment of fetal head station as defined by the ACOG classification. Am J Obstet Gynecol 2005 Mar;192(3):868–874.CrossRefGoogle Scholar
Cohen WR: Normal and abnormal labor. In: Hobbins, JC, Mahoney, MJ, Petrie, RH (eds): Medicine of the Fetus and Mother. Philadelphia: JB Lippincott, 1992.Google Scholar
Hellman, LM, Prystowsky, H: The duration of the second stage of labor. Am J Obstet Gynecol 1952 Jun;63(6):1223–1233.CrossRefGoogle Scholar
Fraser, WD, Cayer, M: Risk factors for difficult delivery in nulliparas with epidural analgesia in second stage of labor. Obstet Gynecol 2002, Mar;99(3): 409–418.Google Scholar
Cohen, WR: Influences of the duration of second stage of labor on perinatal outcome and puerperal morbidity. Obstet Gynecol 1977 Mar;49(3):266–269.Google Scholar
Kadar N: The second stage. In: Studd, J (ed): The Management of Labour. Oxford: Blackwell Scientific Publications, 1985; pp. 271.Google Scholar
Vahratian, A, Troendle, JF: Methodological challenges in studying labour progression in contemporary practice. Paediatr Perinat Epidemiol 2006 Jan;20(1):72–78.CrossRefGoogle Scholar
Plunkett, BA, Peaceman, AM: Management of the second stage of labor in nulliparas with continuous epidural analgesia. Obstet Gynecol 2003 Jul;102(1): 109–114.Google Scholar
American College of Obstetricians and Gynecologists Practice Bulletin Number 49, December 2003: Dystocia and augmentation of labor. Obstet Gynecol 2003 Dec;102(6):1445–1454.
Piper, JM, Bolling, DR: The second stage of labor: Factors influencing duration. Am J Obstet Gynecol 1991 Oct;165(4 Pt 1):976–979.CrossRefGoogle Scholar
Hauth, JC, Hankins, GD, Gilstrap, LC 3rd: Uterine contraction pressures with oxytocin induction/ augmentation. Obstet Gynecol 1986 Sep;68(3 Pt 1): 305–309.CrossRefGoogle Scholar
Seitchik, J, Castillo, M: Oxytocin augmentation of dysfunctional labor. II. Uterine activity data. Am J Obstet Gynecol 1983 Mar;145(5):526–529.CrossRefGoogle Scholar
Borell, U, Fernstrom, I: The movements at the sacroiliac joints and their importance to changes in the pelvic dimensions during parturition. Acta Obstet Gynecol Scand 1958;36(1):54–60.CrossRefGoogle Scholar
Gardosi, J, Hutson, N, B-Lynch, C: Randomised, controlled trial of squatting in the second stage of labour. Lancet 1989 Jul;2(8654):74–77.CrossRefGoogle Scholar
Chen, SZ, Aisaka, K. Mori, H, Kigawa, T: Effects of sitting position on uterine activity in labor. Obstet Gynecol 1987 Jan;69(1):67–73.Google Scholar
Gupta, JK, Hofmeyr, GJ: Position of women during second stage of labour. Cochrane Database Syst Rev 2004;(1):CD002006.CrossRefGoogle ScholarPubMed
Terry, RR, Westcott, J: Postpartum outcomes in supine delivery by physicians vs. nonsupine delivery by midwives. Am J Osteopath Assoc 2006 Apr;106(4):199–202.Google Scholar
Caldwell, WE, Moloy, HC: Anatomic variations in the female pelvis and their effect in labor with a suggested classification. Am J Obstet Gynecol 1933; 26:479–483.CrossRefGoogle Scholar
Steer, CM: Moloy's Evaluation of the Pelvis in Obstetrics, 3rd ed. New York: Plenum Medical Book Company, 1975.CrossRefGoogle Scholar
Klapholz H: Evaluation of fetopelvic relationships. In: Cohen, WR, Friedman, EA (eds): Management of Labor. Baltimore: University Park Press, 1983.Google Scholar
Sandmire, HF: Whither ultrasonic prediction of fetal macrosomia?Obstet Gynecol 1993 Nov;82(5):860–862.Google Scholar
American College of Obstetricians and Gynecologists. Practice Bulletin Number 22: Fetal Macrosomia. Washington, D.C: American College of Obstetricians and Gynecologists, 2000.
Gimovsky, ML, Willard, K, Neglio, M, Howard, T, Zerne, S: X-ray pelvimetry in a breech protocol – a comparison of digital radiography and conventional method. Am J Obstet Gynecol 1985 Dec 15;153(8): 887–888.CrossRefGoogle Scholar
Chauhan, SP, Grobman, WA, Gherman, RA, Chauhan, VB, Chang, G, Magann, EF, Hendrix, NW: Suspicion and treatment of the macrosomic fetus: A review. Am J Obstet Gynecol 2005 Aug;193(2):332–346.CrossRefGoogle Scholar
McNamara, H, Johnson, N, Lilford, R: The effect on fetal arteriolar oxygen saturation resulting from giving oxygen to the mother measured by pulse oximetry. Br J Obstet Gynaecol 1993 May;100(5):446–449.CrossRefGoogle Scholar
Carbonne, B, Cudeville, C, Maillard, F, Goffinet, F, French Study Group on Pulse Oximetry: Predictive value of pulse oximetry and fetal scalp blood ph in the case of meconium-stained amniotic fluid. Eur J Obstet Gynecol Reprod Biol 2003 Jul;109(1):27–32.CrossRefGoogle Scholar
Goodfellow, CF, Hull, MG, Swaab, DF, Dogterom, J, Buijs, RM: Oxytocin deficiency at delivery with epidural analgesia. Br J Obstet Gynaecol 1983 Mar; 90(3):214–219.CrossRefGoogle Scholar
O'Grady, JP, Youngstrom, P: Must epidurals always imply instrumental delivery?Contemp Obs/Gyn 1990;35:19–27.Google Scholar
Thorp, JA, Parisi, VM, Boylan, PC, Johnston, DA: The effect of continuous epidural analgesia on cesarean section for dystocia in nulliparous women. Am J Obstet Gynecol 1989 Sep;161(3):670–675.CrossRefGoogle Scholar
Hoult, IJ, MacLennan, AH, Carrie, : Lumbar epidural analgesia in labour: Relation to fetal malposition and instrumental delivery. Br Med J 1977 Jan; 1(6052):14–16.CrossRefGoogle Scholar
Newton, ER, Schroeder, BC, Knape, KG, Bennett, BL: Epidural analgesia and uterine function. Obstet Gynecol 1995 May;85(5 Pt 1):749–755.CrossRefGoogle Scholar
Sleep J, Roberts J, Chalmers I: Care during the second stage of labour. In Chalmers, I, Enkin, M, Kierse, M (Eds.). Effective Care in Pregnancy and Childbirth. Oxford University Press, 1989; pp. 1129–1199.Google Scholar
Russell, JGB: Moulding of the pelvic outlet. J Obstet Gynaecol Br Commonw 1969;76:817–820.CrossRefGoogle ScholarPubMed
Jeffcoate, TNA, Martin, RHL: Inefficient uterine action. Surg Gynecol Obstet 1952;95:257–273.Google ScholarPubMed
Weiniger, CF, Ginosar, Y. Changes in fetal position during labor and their association with epidural analgesia. Obstet Gynecol 2005 Sep;106(3):642.CrossRefGoogle Scholar
Hillis, DS: Diagnosis of contracted pelvis. Ill Med J 1938;74:131–134.Google Scholar
Compton AA: Avoiding difficult vaginal deliveries. In: Dilts, PV, Sciarra, JJ (eds): Gynecology and Obstetrics, Vol 2. Philadelphia: JB Lippincott, 1990;74; pp. 1–8.Google Scholar
Crichton, D: A reliable method of establishing the level of the foetal head in obstetrics. S Afr Med J 1974 Apr;48(18):784–787.Google Scholar
Vacca, A: Handbook of Vacuum Extraction in Obstetric Practice. London: Edward Arnold, 1992.Google Scholar
Philpott, RH: Obstructed labour. Clin Obstet Gynaecol 1982;9:663–683.Google ScholarPubMed
Rayburn, WF, Siemers, KH, Legino, LJ, Nabity, MR, Anderson, JC, Patil, KD: Dystocia in late labor: Determining fetal position by clinical and ultrasonic techniques. Am J Perinatol 1989 Jul;6(3):316–319.CrossRefGoogle Scholar
Rosen, MG: Management of Labor. New York: Elsevier, 1990.Google Scholar
Cohen, WR, Acker, DB, Friedman, EA (Eds): Management of Labor, 2nd ed. Rockville, MD: Aspen Publishers, 1989.Google Scholar
Cardoza, L, Pearce, JM: Oxytocin in active-phase abnormalities of labor: A randomized study. Obstet Gynecol 1990;75:152–157.Google Scholar
Bidgood, KA, Steer, PJ: A randomized control study of oxytocin augmentation of labour. I. Obstetric outcome. Br J Obstet Gynaecol 1987 Jun;94(6):512–517.CrossRefGoogle Scholar
Seitchik, J: The management of functional dystocia in the first stage of labor. Clin Obstet Gynaecol 1987 Mar;30(1):42–49.CrossRefGoogle Scholar
Studd JWW, Cardozo LD, Gibb DMF: The management of spontaneous labour. In: Studd, JWW (ed): Progress in Obstetrics and Gynaecology, Vol 2. Edinburgh: Churchill-Livingstone, 1982; p. 60.Google Scholar
Bottoms, SF, Hirsch, VJ, Sokol, RJ: Medical management of arrest disorders of labor: A current overview. Am J Obstet Gynecol 1987 Apr;156(4):935–939.CrossRefGoogle Scholar
Huszar, G (ed): The Physiology and Biochemistry of the Uterus in Pregnancy and Labor. Boca Raton, FL: CRC Press, 1986.Google Scholar
Myers, DA, Nathanilesz, PW: Controversies in perinatal care. II. Biologic basis of term and preterm labor. Clin Perinatol 1993;20:9–28.Google Scholar
Cohen WR: The pelvic division of labor. In: Cohen, WR, Friedman, EA (eds): Management of Labor. Baltimore: University Park Press, 1983; pp. 41–64.Google Scholar
Rath, W, Adelmann-Grill, BC, Peiper, U, Kuhn, W: Collagen degradation in the pregnant human cervix at term and after prostaglandin-induced cervical ripening. Arch Gynecol 1987;240(3):177–184.CrossRefGoogle ScholarPubMed
MacKenzie IZ: The therapeutic roles of pro- staglandins in obstetrics. In: Studd, J (ed): Progress in Obstetrics and Gynaecology, vol 8. Edinburgh: Churchill-Livingstone, 1990; pp. 149–174.Google Scholar
Rayburn, WF: Prostaglandin E2 gel for cervical ripening and induction of labor: A critical analysis. Am J Obstet Gynecol 1989 Mar;160(3):529–534.CrossRefGoogle Scholar
Cochrane Database of Syst Rev: 2003 Birth Statistics Reports 54(2)2005:1–116.
MacDorman, MF, Mathews, TJ, Martin, JA: Trends and characteristics of induced labor in the United Stated 1989–98. Paediatr Perinat Epidemiol. 2002 Jul;16(3):263–73.CrossRefGoogle Scholar
Boulvain, M, Kelly, A, Lohse, C, Stn, C, Irion, O: Mechanical methods for induction of labour. Cochrane Database Syst Rev: 2001.Google ScholarPubMed
Bricker, L, Luckas, M: Amniotomy alone for induction of labour. Cochrane Database of Syst Rev 2000; (4):CD002862. Review.CrossRefGoogle ScholarPubMed
Bujold, E, Blackwell, S, Gauthier, RJ: Cervical ripening with transcervical Foley catheter and the risk of uterine rupture. Obstet Gynecol 2004 Jan;103(1):18–23.CrossRefGoogle Scholar
Karjane, NW, Brock, EL, Walsh, SW: Induction of labor using a Foley balloon, with and without extra-amniotic saline infusion. Obstet Gynecol 2006 Feb;107(2 Pt 2):234–239.CrossRefGoogle Scholar
Gilson, GJ, Russell, DJ, Izquierdo, , Qualls, CR, Curet, LB: A prospective randomized evaluation of a hygroscopic cervical dilator, Dilapan, in the preinduction ripening of patients undergoing induction of labor. Am J Obstet Gynecol 1996 Jul;175(1):145–149.CrossRefGoogle Scholar
Dodd, JM, Crowther, CA, Robinson, JS: Oral misoprostol for induction of labour at term: Randomized controlled trial. Br Med J 2006 Mar 4;332(7450):509–513.CrossRefGoogle Scholar
Rayburn, WF, Powers, BL, Plasse, TF, Carr, D, Di, Spirito M: Pharmacokinetics of a controlled-release misoprostol vaginal insert at term. J. Soc Gynecol Investig 2006 Feb;13(2):112–117.CrossRefGoogle Scholar
Bishop, EH: Pelvic scoring for elective induction. Obstet Gynecol 1964 Aug;24:266–268.Google Scholar
Boylan, PC, Parisi, VM: Effect of active management on latent phase labor. Am J Perinatol 1990 Oct;7(4):363–365.CrossRefGoogle Scholar
Seitchik, J: The management of functional dystocia in the first stage of labor. Clin Obstet Gynecol 1987 Mar;30(1):42–49.CrossRefGoogle Scholar
Wein, P: Efficacy of different starting doses of oxytocin for induction of labor. Obstet Gynecol 1989 Dec;74(6):863–868.Google Scholar
Satin, AJ, Hankins, GDV, Yeomans, ER: A prospective study of two dosing regimens of oxytocin for the induction of labor in patients with unfavorable cervices. Am J Obstet Gynecol 1991 Oct;165(4 Pt 1): 980–984.CrossRefGoogle Scholar
Gee H, Olah KS: Failure to progress in labour. In: Studd, J (ed): Progress in Obstetrics and Gynecology, Vol 10. Edinburgh: Churchill-Livingstone, 1992; pp. 159–181.Google Scholar
Dodd, JM, Crowther, CA, Robinson, JS: Morning compared with evening induction of labor: A nested, randomized controlled trial. Obstet Gynecol 2006 Aug;108(2):350–360.CrossRefGoogle Scholar
Rogers, RG, Gardner, MO, Tool, KJ, Ainsley, J, Gilson, G: Active management of labor: A cost analysis of a randomized controlled trial. West J Med 2000 Apr;172 (4):240–243.CrossRefGoogle Scholar

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