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Aim of the study was to analyse data on cervical dilation and fetal descent patterns in low-risk women, who did or did not receive intermittent low-dose epidural analgesia (EA), and who had either a vaginal or a caesarean delivery.
Therefore, we conducted a retrospective analysis, retrieving data from October 1st 2008 to October 31st 2018. We selected 6030 women categorized as Robson Group 1, divided into four groups according to the mode of delivery (vaginal or caesarean) and the presence of EA:
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| VD-e | Women who vaginally delivered and received EA for labour. | ||
| VD-n | Women who vaginally delivered and did not receive EA for labour. | ||
| CD-e | Women who delivered via intrapartum caesarean section and received EA for labour. | ||
| CD-n | Women who delivered via intrapartum caesarean section and did not receive EA for labour. |
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| Measure | Description | Time Frame |
|---|---|---|
| Cervical dilation curve | We modeled the cervical dilation curve using a high-degree mixed polynomial regression. The analysis was conducted separately in women with vaginal or caesarean delivery. The time of complete cervical dilation or caesarean delivery was considered the point 0 for cervical dilation, while the preceding events resulted in negative time compared to the 0. | First stage of labour (from admission to the delivery suite to full cervical dilation) |
| Fetal head descent curve | We modeled the fetal head descent curve using a mixed polynomial regression. The analysis was conducted separately in women with vaginal or caesarean delivery. The time of station +3 (i.e. vaginal birth) or caesarean delivery was considered the point 0 , while the preceding events resulted in negative time compared to the 0. | From admission to the delivery room up to the time of delivery (either via vaginal route or caesarean section) |
| Measure | Description | Time Frame |
|---|---|---|
| Length of active phase | The beginning of the active phase was defined in the presence of regular painful uterine contractions, a substantial degree of cervical effacement and more rapid cervical dilation. Active phase ends at full cervical dilation. | Up to 24 hours from admission. |
| Length of second stage |
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Inclusion Criteria:
Exclusion Criteria:
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Pregnant patients classified as Robson class 1, who received or not EA for labour and delivered either vaginally or via caesarean route.
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Fondazione Policlinico Universitario A. Gemelli IRCCS | Rome | RM | 00168 | Italy |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 29781504 | Background | Anim-Somuah M, Smyth RM, Cyna AM, Cuthbert A. Epidural versus non-epidural or no analgesia for pain management in labour. Cochrane Database Syst Rev. 2018 May 21;5(5):CD000331. doi: 10.1002/14651858.CD000331.pub4. | |
| 33837643 | Background | de Vries BS, Mcdonald S, Joseph FA, Morton R, Hyett JA, Phipps H, McGeechan K. Impact of analysis technique on our understanding of the natural history of labour: a simulation study. BJOG. 2021 Oct;128(11):1833-1842. doi: 10.1111/1471-0528.16719. Epub 2021 May 19. |
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For patient's privacy protection.
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Second stage begins at full cervical dilation and ends at delivery. |
| Up to 24 hours from admission. |
| Type of vaginal delivery | In the VD-e and VD-n groups, description of the type of delivery (eutocic or instrumental) | At delivery |
| Maternal complications during vaginal delivery | Rate of maternal complications (postpartum haemorrhages, perineal lacerations, uterine atony) in the VD groups. | At delivery. |
| Episiotomy | Rate of episiotomy in the VD groups. | At delivery. |
| Fetal indicators | Apgar at 1 and 5 minutes, admission in Neonatal Intensive Care Unit (NICU), death | After delivery |
| 16420344 | Background | Vahratian A, Troendle JF, Siega-Riz AM, Zhang J. Methodological challenges in studying labour progression in contemporary practice. Paediatr Perinat Epidemiol. 2006 Jan;20(1):72-8. doi: 10.1111/j.1365-3016.2006.00696.x. |
| 717493 | Background | Friedman EA. Evolution of graphic analysis of labor. Am J Obstet Gynecol. 1978 Dec 1;132(7):824-7. doi: 10.1016/s0002-9378(78)80018-0. No abstract available. |
| 12388957 | Background | Zhang J, Troendle JF, Yancey MK. Reassessing the labor curve in nulliparous women. Am J Obstet Gynecol. 2002 Oct;187(4):824-8. doi: 10.1067/mob.2002.127142. |
| 21099592 | Background | Zhang J, Landy HJ, Ware Branch D, Burkman R, Haberman S, Gregory KD, Hatjis CG, Ramirez MM, Bailit JL, Gonzalez-Quintero VH, Hibbard JU, Hoffman MK, Kominiarek M, Learman LA, Van Veldhuisen P, Troendle J, Reddy UM; Consortium on Safe Labor. Contemporary patterns of spontaneous labor with normal neonatal outcomes. Obstet Gynecol. 2010 Dec;116(6):1281-1287. doi: 10.1097/AOG.0b013e3181fdef6e. |