Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2020

Open Access 01-12-2020 | Sectio Ceasarea | Research article

Pre- and during- labour predictors of dystocia in active phase of labour: a case-control study

Authors: Jila Nahaee, Fatemeh Abbas-Alizadeh, Mojgan Mirghafourvand, Sakineh Mohammad-Alizadeh-Charandabi

Published in: BMC Pregnancy and Childbirth | Issue 1/2020

Login to get access

Abstract

Background

Labour dystocia (LD) is associated with maternal and foeto-neonatal complications and increased rate of caesarean section. There are scant studies on predictive factors of labour dystocia in Iran, as well as in other countries. Therefore, this study aimed to identify the predictive factors of LD using an integrated and collaborative pre- and during- labour factors to help formulate more effective intervention strategies for prevention and management of LD.

Methods

In this case-control study, 350 women with and 350 women without LD, matched individually in terms of parity and hospital, were compared. The participants were in active labor, had singleton pregnancy, live foetus with a cephalic presentation, gestational age of 37+ 0–41+ 6 weeks, and were hospitalized for vaginal birth in two teaching hospitals in Tabriz, Iran. Data related to the socio-demographic characteristics, anxiety status (using the Spielberger State Anxiety Inventory), and woman dehydration were collected at cervical dilatation between 4 and 6 cm (before dystocia detection) and the other data at different phases of labour, and after birth (before discharge). The multivariate logistic regression was used to determine the predictors.

Results

The predictors of LD were severe [OR 58.0 (95% CI 26.9 to 125.1)] and moderate [8.6 (4.2 to 17.4)] anxiety, woman dehydration > 3 h [18.67 (4.0 to 87.3)] and ≤ 3 h [2.8 (1.7 to 4.8], insufficient support by the medical staff in the delivery room [5.8 (1.9 to 17.9)], remifentanil administration [3.1 (1.5 to 6.2)], labour induction [4.2 (2.5 to 7.2], low income [2.0 (1.2 to 3.3)], woman’s height < 160 cm [2.0 (1.1 to 3.3)], and woman age of 16–20 y [0.3 (0.2 to 0.6)]. The proportion of the variance explained by all these factors was 74%.

Conclusion

The controllable predictors, such as woman anxiety and dehydration, and insufficient support from medical staff during labour were strongly associated with the risk of LD. Therefore, it seems that responding to woman physical, psychological, and supportive needs during labour can play a significant role in LD prevention and control.

Ethical code

IR.TBZMED.REC.1397.624.
Appendix
Available only for authorised users
Literature
1.
Ressel GW. ACOG releases report on dystocia and augmentation of labor. Am Fam Physician. 2004;69(5):1285–300..
2.
Kjærgaard H, Olsen J, Ottesen B, Dykes AK. Incidence and outcomes of dystocia in the active phase of labor in term nulliparous women with spontaneous labor onset. Acta Obstet Gynecol Scand. 2009;88(4):402–7.PubMed
3.
El-Hamamy E, Arulkumaran S. Poor progress of labour. Curr Obstet Gynaecol. 2005;15:1–8.
4.
Conningham FG, Bloom SL, Leveno KJ, Dash JS, Hoffman BM, Casey BM, et al. Williams obstetrics, vol. 1, 25th ed. New York: Mc Graw hill; 2018.
5.
Ahmari-Tehran H, Kachouei A, Heydari A, Salahshourian A, Ahangari R. The prevalence and related factors of hard labor. IJN. 2010;22(62):65–74.
6.
Alijahan R, Kordi M. Risk factors of dystocia in nulliparous women. IJMS. 2014;39(3):254–60.PubMed
7.
Dencker A, Berg M, Bergqvist L, Ladfors L, Thorsen LS, Lilja H. Early versus delayed oxytocin augmentation in nulliparous women with prolonged labour--a randomised controlled trial. BJOG. 2009;116(4):530–6.PubMed
8.
Thomas J, Paranjothy S. National Sentinel Caesarean Section Audit Report. London: RCOG Press; 2001.
9.
10.
Azami-Aghdash S, Ghojazadeh M, Dehdilani N, Mohammadi M, Asl Amin Abad R. Prevalence and causes of cesarean section in Iran: systematic review and meta-analysis. Iran J Public Health. 2014;43(5):545–55.PubMedPubMedCentral
11.
Rezaee M, Shahoei R, Shah Gheibi S. Evaluation of trends in cesarean section and its causes in Besat Hospital of Sanandaj. Iran J Public Health. 2015;1(2):29–36.
12.
Sheiner E, Levy A, Feinstein U, Hallak M, Mazor M. Risk factors and outcome of failure to progress during the first stage of labor: a population-based study. Midwifery. 2002;81(3):222–6.
13.
Selin L, Wallin G, Berg M. Dystocia in labour–risk factors, management and outcome: a retrospective observational study in a Swedish setting. Acta Obstet Gynecol Scand. 2008;87(2):216–21.PubMed
14.
Kjærgaard H, Olsen J, Ottesen B, Nyberg P, Dykes AK. Obstetric risk indicators for labour dystocia in nulliparous women: a multi-Centre cohort study. BMC Pregnancy Childbirth. 2008;8:45.PubMedPubMedCentral
15.
O'Driscoll K, Foley M, MacDonald D. Active management of labor as an alternative to cesarean section for dystocia. Obstet Gynecol. 1984;63(4):485–90.PubMed
16.
Högberg U, Lekås Berg ML. Prolonged labour attributed to large fetus. Gynecol Obstet Investig. 2000;49(3):160–4.
17.
18.
Spielberger CD. Test anxiety inventory: "test attitude inventory". Palo Alto, Calif.: Consulting Psychologists Press; 1980.
19.
20.
Zhang J, Troendle J, Mikolajczyk R, Sundaram R, Beaver J, Fraser W. The natural history of the normal first stage of labor. Obstet Gynecol. 2010;115(4):705–10.PubMed
21.
Goodman P, Mackey MC, Tavakoli AS. Factors related to childbirth satisfaction. JAN. 2004;46(2):212–9.
22.
Riley RD, Snell KI, Ensor J, Burke DL, Fe H Jr, Moons KG, et al. Minimum sample size for developing a multivariable prediction model: PART II - binary and time-to-event outcomes. Stat Med. 2019;38(7):1276–96.PubMed
23.
Young TK, Woodmansee B. Factors that are associated with cesarean delivery in a large private practice: the importance of prepregnancy body mass index and weight gain. Am J Obstet Gynecol. 2002;187(2):312–8.PubMed
24.
Laursen M, Johansen C, Hedegaard M. Fear of childbirth and risk for birth complications in nulliparous women in the Danish National Birth Cohort. BJOG. 2009;116(10):1350–5.PubMed
25.
Lederman RP, Lederman E, Work BA, McCann DS. The relationship of maternal anxiety, plasma catecholamines, and plasma cortisol to progress in labor. Am J Obstet Gynecol. 1978;132(5):495–500.PubMed
26.
Kabakyenga JK, Östergren PO, Turyakira E, Mukasa PK, Pettersson KO. Individual and health facility factors and the risk for obstructed labour and its adverse outcomes in South-Western Uganda. BMC Pregnancy Childbirth. 2011;11(1):73.PubMedPubMedCentral
27.
Azarbayjani MA, Tojari F, Habibinejad M. The relation between obesity, physical activity and socioeconomic status among girl students living in northern Tehran. FEYZ. 2011;15(2):132–8.
28.
Khodakarami N, Naji H, Dashti MG, Yazdjerdi M. Woman abuse and pregnancy outcome among women in Khoram Abad. EMHJ. 2009;15(3):622–8.PubMed
29.
Gisladottir A, Luque-Fernandez MA, Harlow BL, Gudmundsdottir B, Jonsdottir E, Bjarnadottir RI, et al. Obstetric outcomes of mothers previously exposed to sexual violence. PLoS One. 2016;11(3):e0150726.PubMedPubMedCentral
30.
Finnbogadóttir H, Dejin-Karlsson E, Dykes AK. A multi-Centre cohort study shows no association between experienced violence and labour dystocia in nulliparous women at term. BMC Pregnancy Childbirth. 2011;11(1):14.PubMedPubMedCentral
31.
Guirgis RR, Clark AD, Hogston P, Golland IM, Bevan JR, Francis JG, et al. The effects of smoking on labour after uncomplicated pregnancy: a comparison between the progress and outcome of labour in 400 smokers and 400 matched non-smokers. J Obstet Gynaecol. 1997;17(2):149–52.PubMed
32.
Quenby S, Pierce SJ, Brigham S, Wray S. Dysfunctional labor and myometrial lactic acidosis. Obstet Gynecol. 2004;103(4):718–23.PubMed
33.
Kjaergaard H, Dykes A-K, Ottesen B, Olsen J. Risk indicators for dystocia in low-risk nulliparous women: a study on lifestyle and anthropometrical factors. J Obstet Gynaecol. 2010;30(1):25–9.PubMed
34.
35.
Neilson JP, Lavender T, Quenby S, Wray S. Obstructed labour. Br Med Bull. 2003;67(1):191–204.PubMed
36.
Madhavanprabhakaran GK, Kumar KA, Ramasubramaniam S, Akintola AA. Effects of pregnancy related anxiety on labour outcomes. JRNM. 2013;2(7):96–103.
37.
Rajabi F, Amir Ali Akbari S, Shams J, Alavi Majd H. Correlation between anxiety in labor and duration as well as outcome. Adv Nurs Midwifery. 2012;22(75):45–51.
38.
Davies BL, Hodnett E. Labor support: nurses' self-efficacy and views about factors influencing implementation. JOGNN. 2002;31(1):48–56.PubMed
39.
Bohren MA, Hofmeyr GJ, Sakala C, Fukuzawa RK, Cuthbert A. Continuous support for women during childbirth. Cochrane Database Syst Rev. 2017;7:Cd003766.PubMed
40.
Wang M, Song Q, Xu J, Hu Z, Gong Y, Lee AC, et al. Continuous support during labour in childbirth. BMC Pregnancy Childbirth. 2018;18:480.PubMedPubMedCentral
41.
Johnson DP, Davis NR, Brown AJ. Risk of cesarean delivery after induction at term in nulliparous women with an unfavorable cervix. Am J Obstet Gynecol. 2003;188(6):1565–9.PubMed
42.
Boulvain M, Marcoux S, Bureau M, Fortier M, Fraser W. Risks of induction of labour in uncomplicated term pregnancies. Paediatr Perinat Epidemiol. 2001;15(2):131–8.PubMed
43.
Anderson BC. The use of Remifentanil as the primary agent for analgesia in Parturients. Crit Care Nurs Clin. 2017;29(4):495–517.
44.
Ecker JL, Chen KT, Cohen AP, Riley LE, Lieberman ES. Increased risk of cesarean delivery with advancing maternal age: indications and associated factors in nulliparous women. Am J Obstet Gynecol. 2001;185(4):883–7.PubMed
45.
Main DM, Main EK, Moore DH. The relationship between maternal age and uterine dysfunction: a continuous effect throughout reproductive life. Am J Obstet Gynecol. 2000;182(6):1312–20.
Metadata
Title
Pre- and during- labour predictors of dystocia in active phase of labour: a case-control study
Authors
Jila Nahaee
Fatemeh Abbas-Alizadeh
Mojgan Mirghafourvand
Sakineh Mohammad-Alizadeh-Charandabi
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2020
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-020-03113-5

Other articles of this Issue 1/2020

BMC Pregnancy and Childbirth 1/2020 Go to the issue

Research article

Gestational weight gain counselling practices among different antenatal health care providers: a qualitative grounded theory study

Research article

The influence of experiential knowledge and societal perceptions on decision-making regarding non-invasive prenatal testing (NIPT)

Research article

High dose and low dose oxytocin regimens as determinants of successful labor induction: a multicenter comparative study

Research article

“An unnecessary cut?” multilevel health systems analysis of drivers of caesarean sections rates in Italy: a systematic review

Research article

Perinatal outcomes in Finnish twins: a retrospective study

Research article

Herbal medicine use and predictors among pregnant women attending antenatal care in Ethiopia: a systematic review and meta-analysis