Authors: Antje Petersen Ulrich Poetter Claire Michelsen Mechthild M Gross
Publish Date: 2013/02/16
Volume: 288, Issue: 2, Pages: 245-254
Abstract
A longitudinal multicenter cohort study included data from 3955 lowrisk women who gave birth in hospitals in Lower Saxony Germany We analyzed three intrapartum interventions amniotomy oxytocin augmentation and epidural analgesia We divided births into time intervals delineated by these interventions and noted cervical dilation at interval onset We analyzed the duration of intervals from onset of labor until the first intervention and between intrapartum interventions with Kaplan–Meier’s estimate regarding the three interventions as competing risks Further we analyzed the cervical dilation before an intervention by Kaplan–Meier’s estimate without censoring732 of the included 2082 nulliparae n = 1525 and 596 of the included 1873 multiparae n = 1117 received at least one intervention while 1313 women 332 experienced a normal labor without any of these interventions The intervals from onset of labor until the first intervention and from the first until the second intervention were significantly shorter in multiparae than in nulliparae The intervention cascade in nulliparae most often started with epidural analgesia in early labor n = 579 278 Oxytocin augmentation most often followed after a short interval n = 343 592 median 157 h In multiparae amniotomy was most often the first intervention n = 629 336 and spontaneous birth most often followed n = 503 800 Labor duration and operative deliveries increased as interventions increased
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