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Prevalence of Prolonged Latent Phase and Labor Outcome: Review of Birth Records in a Swedish Population
Women’s Department, Central Hospital, Karlstad, Sweden.
Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013). Inland Norway Univ Appl Sci, Fac Publ Hlth, Dept Nursing, Elverum, Norway.ORCID iD: 0000-0001-7082-6834
Department of Health Sciences, Mid Sweden University, Sundsvall, .
Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).ORCID iD: 0000-0003-1382-4386
2018 (English)In: Journal of midwifery & women's health, ISSN 1526-9523, E-ISSN 1542-2011, Vol. 63, no 1, p. 33-44, article id JMWH12704Article in journal (Refereed) Published
Abstract [en]

The prevalence of a prolonged latent phase of labor has been described as ranging from 5% to 6.5% in previous research. The aim of this study was to describe the prevalence of the prolonged latent phase of 18 hours or more, based on women's report, in women intending vaginal birth and who had spontaneous onset of labor. An additional aim was to compare the incidence of obstetric interventions, and the labor and neonatal outcomes in women with and without a prolonged latent phase.

METHODS:

A descriptive and comparative study was performed in a mid-sized hospital in western Sweden. The sample consisted of 1343 birth records of women who intended vaginal births and who had spontaneous onset of labor at 37 or more weeks' gestation during a one-year period (2013-2014). Background characteristics, obstetric interventions, and labor and neonatal outcomes were compared between women with latent phases lasting less than 18 hours and 18 hours or more, based on women's self-report. Odds ratios with 95% confidence intervals were calculated for the different exposure variables.

A prolonged latent phase lasting 18 hours or more occurred in 23% of all births analyzed (n = 1343). A prolonged latent phase was more common among nulliparous women (29.2%) but also common for multiparous women (17%). Nulliparous and multiparous women who experienced a prolonged latent phase were more often exposed to amniotomy during latent phase. For nulliparous women, the adjusted odds ratio (aOR) was 11.57 (95% confidence interval [CI], 5.25-25.51) and for multiparous women the aOR was 18.73 (95% CI, 9.06-38.69). Similarly, amniotomy during active phase was more common for both nulliparous and multiparous women who experienced a prolonged latent phase (aOR, 4.05; 95% CI, 2.53-6.47 and aOR, 3.93; 95% CI, 2.43-6.37, respectively). Women with latent phases of 18 hours or more, more often experienced augmentation of labor during all phases, especially during latent phase. For nulliparous women, the aOR was 10.13 (95% CI, 2.82-36.39) and for multiparous women, aOR was11.9 (95% CI, 3.69-38.71). A prolonged latent phase was associated with more instrumental vaginal births for multiparas (aOR, 2.58; 95% CI, 1.27-5.26) and emergency cesarean regardless of parity (nulliparous women: aOR, 3.21; 95% CI, 1.08-9.50 and multiparous women: aOR, 3.93; 95% CI, 1.67-9.26).

Based on women's self-report, the prevalence of a prolonged latent phase in women at term who planned a vaginal birth and had spontaneous onset of labor was higher than previously reported. Women with a prolonged latent phase were more likely to receive obstetric interventions. Assisted vaginal birth was more common for nulliparous women with prolonged latent phase and emergency cesarean occurred more frequently for both nulliparous women and multiparous women with a prolonged latent phase.

Place, publisher, year, edition, pages
Hoboken: John Wiley & Sons, 2018. Vol. 63, no 1, p. 33-44, article id JMWH12704
Keywords [en]
intrapartum care, labor, first stage, obstetric complications, quantitative research
National Category
Nursing Obstetrics, Gynecology and Reproductive Medicine Public Health, Global Health, Social Medicine and Epidemiology Clinical Science Obstetrics, Gynecology and Reproductive Medicine
Research subject
Nursing Science; Public Health Science
Identifiers
URN: urn:nbn:se:kau:diva-64681DOI: 10.1111/jmwh.12704ISI: 000424649100005PubMedID: 29419927OAI: oai:DiVA.org:kau-64681DiVA, id: diva2:1149115
Available from: 2017-10-13 Created: 2017-10-13 Last updated: 2018-10-23Bibliographically approved
In thesis
1. Prolonged latent phase of labour: Prevalence, labour outcomes, quality of care, women’s experiences and preferences, and psychometric properties of a questionnaire
Open this publication in new window or tab >>Prolonged latent phase of labour: Prevalence, labour outcomes, quality of care, women’s experiences and preferences, and psychometric properties of a questionnaire
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to investigate the prevalence and labour outcome of a prolonged latent phase of labour, quality of care, women’s experiences and preferences during labour, and to psychometrically test a questionnaire.

Methods: Qualitative and quantitative methods. Sixteen primiparous women’s preferences for care during a prolonged latent phase of labour were studied with focus-group and individual interviews and analysed with content analysis (I). From a one-year cohort of 2660 women, 1554 women with a spontaneous onset of labour were invited to participate and 1389 women accepted invitation (II-IV). Data from 1343 women’s birth records were analysed with descriptive and analytic statistics (II). 758 women, (RR 64%), 343 primiparous and 415 multiparous, responded to the Intrapartal-specific Quality from Patients Perspective Questionnaire, QPP-I (III), the Early Labour Experience Questionnaire, ELEQ (IV) and additionally birth-related items. Data were analysed with descriptive, analytic, and psychometric statistics.

Main findings: According to women’s self-reports, 23% of women with a spontaneous onset of labour had a prolonged latent phase (>18 hours), which was associated with more obstetrical interventions and instrumental births (II). These women preferred individualised care (I), rated the quality of their intrapartum care lower, were less content with the birth experience, and had more negative feelings during labour and birth than women with a shorter latent phase (III). The ELEQ was translated and adapted to Swedish and resulted in two questionnaires, one for primiparous women, SWE-ELEQ-PP, and one for multiparous women, SWE-ELEQ-MP. Both are valid and reliable and can be used to evaluate early labour care in Sweden (IV).

Conclusions: A prolonged latent phase of labour can be regarded as a risk factor. It can result in more obstetrical interventions, more instrumental births, a lower perceived quality of care, and a more negative birth experience regardless of parity. Differences in parity must be considered when evaluating early labour care during the latent phase of labour, with special focus to primiparous women.

Abstract [en]

Women’s preferences are not always adequately met during the latent phase of labour. Further exploration is needed to investigate the experiences, preferences, and labour outcome of women with a prolonged latent phase. The overall aim of this thesis was to investigate the prevalence and labour outcomes of a prolonged latent phase, quality of care, women’s experiences and preferences during labour, and to psychometrically test a questionnaire. The prevalence of a prolonged latent phase of labour was 23% of women with a spontaneous onset of labour and was associated with more obstetrical interventions and instrumental births. These women preferred individualised care, rated the quality of their intrapartum care lower, were less content with the birth experience, and had more negative feelings during labour and birth than women with a shorter latent phase. A questionnaire about experiences during early labour was adapted and can be used to evaluate early labour care in Sweden for both primiparous and multiparous women. A prolonged latent phase of labour can be regarded as a risk factor, and differences in parity must be considered when evaluating early labour care. Special focus should be on primiparous women, and a women-centred perspective is required for management during the latent phase of labour, regardless of parity.

Place, publisher, year, edition, pages
Karlstads universitet, 2018. p. 76
Series
Karlstad University Studies, ISSN 1403-8099 ; 2018:49
Keywords
birth experience, prolonged latent phase of labour, quality of care, psychometric evaluation
National Category
Health Sciences
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-69804 (URN)978-91-7063-889-3 (ISBN)978-91-7063-984-5 (ISBN)
Public defence
2018-12-07, Lagerlöfsalen, 1A 305, Karlstads universitet, Karlstad, 13:00 (Swedish)
Opponent
Supervisors
Funder
Landstinget i Värmland
Available from: 2018-11-13 Created: 2018-10-23 Last updated: 2018-11-13Bibliographically approved

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Wilde-Larsson, BodilSandin-Bojö, Ann-Kristin

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