ASSESSMENT OF THE VARIABILITY OF CERVICAL DILATATION RATE IN THE FIRST STAGE OF LABOR AT AL- ELWIYA MATERNITY TEACHING HOSPITAL

Abstract

Managing labor has long been based on the Friedmans labor curve which gives the cervical dilatation as predictable and sigmoidal. But modern studies indicate a less active development of labor and a greater changeability. The purpose of this study was to assess the rates of cervical dilatation in Arabian women, study the relationship between the mode of delivery and cervical dilatation, and determine thresholds that predict dystocia and cesarean delivery.

A follow-up study was carried out in Al-Elwiya Maternity Teaching Hospital, Baghdad, on 1,000 term women who delivered their infants in spontaneous labor and singleton births. Women who have had a previous cesarean section or malpresentation or have medical complication were excluded. Serial vaginal examinations were used to measure cervical dilatation both in the latent and active stages. The predictors of cesarean delivery were determined with the help of multivariate logistic regression and Receiver Operating Characteristic (ROC) analysis which consider the parity, BMI, and gestational age.

The rate of cesarean section was 15.5% as a result of dystocia. The median rates of cervical dilatation were 0.4 cm/h in the latent and 0.6 cm/h in the active phases, which is slower than Friedman standard yet is in line with current research. Admission dilatation of <4 cm, rate of dilatation of less than 0.5 cm/hour, nulliparity and a BMI of 30 or more were significant predictors of cesarean delivery. Using ROC analysis, it was found that optimal predictive thresholds were at 0.4-0.5 cm / hour.

These results indicate that the development of labor among the Iraqi women is less developed as compared to the traditional standards and strict use of the old-fashioned standards can be a cause of unnecessary cesarean sections.