OBSTETRIC OUTCOMES AMONG LOW RISK PARTURIENTS WHEN ACTIVE PHASE OF LABOR
IS DEFINED AT A CERVICAL DILATATION OF 6 VERSUS 4 CENTIMETRES AT
KENYATTA NATIONAL HOSPITAL, KENYA
Abstract
Background: Neal et al. suggested that active labor started at 6
centimeters (cm) cervical dilatation which differs from Friedman’s labor
curve of 4cm. The feasibility and risk of adverse obstetric outcomes
when active labor starts at 4cm compared to 6cm dilatation has not been
studied amongst African women. Objective: Compare incidences of adverse
obstetric outcomes among low-risk parturients when active labor starts
at 6cm versus 4cm dilatation. Methodology:180 low-risk parturients in
spontaneous labor between 37-42 weeks gestation with a singleton fetus
in cephalic presentation and reassuring fetal status were recruited,
allotted to 4 cm or 6 cm arms and intrapartum and immediate postpartum
outcomes recorded. Demographic characteristics were summarized and
Chi-square tests used to evaluate relationships between study arms.
P-value was considered significant at <0.05 at the 95% level
of confidence. Results: Between January and April 2019, 90 parturients
each were recruited to the 4cm and 6cm arms. Demographic and
reproductive characteristics were comparable on admission. Defining
active labor at cervical dilatation of 4 cm versus 6 cm was not
associated with adverse maternal and neonatal outcomes. However, the
need for amniotomy and oxytocin was 1.44 (1.09-1.96) and 1.42
(1.07-1.88) times higher when active labor was defined as cervical
dilation of 4 cm than 6 cm (P<0.05). Conclusion: Defining
active labor at cervical dilatation of 4 cm versus 6 cm was not linked
with adverse obstetric outcomes. However, defining active labor at 4 cm
than 6 cm increased the risk of amniotomy and oxytocin administration
1.44 and 1.42-fold.