Predictive value of cervimetric labour patterns in primigravidae

TLDR

The authors analyzed 684 primigravid labours from a 2000‑patient cohort, using partograms and a labour stencil to detect dysfunctional first‑stage cervical progress and applying a standard oxytocin augmentation protocol. They found that normal cervimetric patterns predicted a 98.4 % vaginal delivery rate, while dysfunctional patterns improved to 93.8 % with oxytocin but fell to 22.7 % when unresponsive; prolonged latent phase raised caesarean rates to 16.7 %, and the overall caesarean rate was 8.7 % with no increase in perinatal morbidity.

Abstract

From a study of 2000 consecutive labours the outcome of the 684 primigravid patients admitted in spontaneous labour has been examined according to their cervimetric progress during the first stage of labour. A partogram and labour stencil were used to identify dysfunctional labour which was treated with a standard protocol of augmentation by oxytocin. This policy achieved labours with a mean 'observed first stage' of 6.3 h and a caesarean section rate of 8.7%. There was one stillbirth due to multiple congenital abnormalities and no increase in perinatal morbidity. Our data show that the type of first stage cervimetric pattern is helpful in predicting the outcome of labour. A normal cervimetric pattern resulted in a vaginal delivery rate of 98.4%; primary dysfunctional labour, which could be improved by oxytocin, had a 93.8% incidence of vaginal delivery, but if there was no improvement in the rate of cervical dilatation when this was administered the vaginal delivery rate was only 22.7% . A prolonged latent phase was associated with a caesarean section rate of 16.7% and the incidence of neonatal intubation was nearly as high as that found in uncorrected primary dysfunctional labour. The neonatal asphyxia in secondary arrest was minimal with an overall caesarean section rate of 28.4%; there was no increased incidence of neonatal morbidity with this cervimetric type.