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Predictors of Individual Labor Progress in a Cohort of Israeli Nulliparous Laboring Women
Abstract Number: T-05
Abstract Type: Original Research
Background: Individual patient characteristics may contribute to the progress and pain of labor, and previous models have been used to study the effect of characteristics on labor pain and progress.
Methods: The local IRB approved a prospective study of nulliparous laboring women who all received labor epidural analgesia (LEA). We evaluated cervical dilation at placement of epidural analgesia 60, 120 cm, pain intensity (numerical pain rating scale, NPRS) at LEA placement, 60, 120 and 2nd stage, and duration of 2nd stage. We created a population labor progress model using a biexponential function that identifies latent and active phases of labor, and the cervical dilation at which transition occurs. Labor pain was modeled as a sigmoid function of cervical dilation using previously validated models.(1,2) Association between inter-individual variability and maternal weight, age, fetal weight, duration of 2nd stage, maternal ethnicity and country of origin was assessed. Variables with association at P<0.05 were considered for inclusion into a final predictive model.
Results: We present data for 105 nulliparas with mean age31±4yrs; gestational age 40±1wks; BMI 22±3kg/m2. 71% were born in Israel and multiple ethnicities were reported, majority Ashkenazi, 41%. The following factors were significantly associated with labor progress: maternal age on latent labor (P=0.047), maternal weight on latent labor (P=0.002), fetal weight on the transition point between latent and active labor (P=0.0003), duration of 2nd stage and rate of latent labor (P=0.002), birth country (Israel vs other) on the transition point between active and latent labor (P=0.003). Ethnicity did not influence labor progress. In the corrected model, only birth country and fetal weight significantly affected the cervical dilation at which transition between latent and active labor occurs (P=0.0002).
Conclusions: As previously demonstrated fetal weight is an important factor in labor progress. Israel is a melting pot and many women had mixed ethnicities. Being born in Israel was associated with transition to active labor at a smaller cervical dilation, while there was no effect of ethnicity. Asian ethnicity has previously been associated with slower transition, however there is little representation of nulliparas of Asian descent in this cohort.
Refs: 1)Quincy Am J Perinatol 2014;31:745. 2)Debiec Anesthesiology 2009;111:1093