Labor curves based on cervical dilatation over time and their accuracy and effectiveness: A systematic scoping review

Objectives: This systematic scoping review was conducted to 1) identify and describe labor curves that illustrate cervical dilatation over time; 2) map any evidence for, as well as outcomes used to evaluate the accuracy and effectiveness of the curves; and 3) identify areas in research that require further investigation. Methods: A three-step systematic literature search was conducted for publications up to May 2023. We searched the Medline, Maternity & Infant Care, Embase, Cochrane Library, Epistemonikos, CINAHL, Scopus, and African Index Medicus databases for studies describing labor curves, assessing their effectiveness in improving birth outcomes, or assessing their accuracy as screening or diagnostic tools. Original research articles and systematic reviews were included. We excluded studies investigating adverse birth outcomes retrospectively, and those investigating the effect of analgesia-related interventions on labor progression. Study eligibility was assessed, and data were extracted from included studies using a piloted charting form. The findings are presented according to descriptive summaries created for the included studies. Results and implications for research: Of 26,073 potentially eligible studies, 108 studies were included. Seventy-three studies described labor curves, of which ten of the thirteen largest were based mainly on the United States Consortium on Safe Labor cohort. Labor curve endpoints were 10 cm cervical dilatation in 69 studies and vaginal birth in 4 studies. Labor curve accuracy was assessed in 26 studies, of which all 15 published after 1986 were from low- and middle–income countries. Recent studies of labor curve accuracy in high-income countries are lacking. The effectiveness of labor curves was assessed in 13 studies, which failed to prove the superiority of any curve. Patient-reported health and well-being is an underrepresented outcome in evaluations of labor curves. The usefulness of labor curves is still a matter of debate, as studies have failed to prove their accuracy or effectiveness

The perspectives of nurse-midwives and doctors on clinical challenges of prolonged labor: A qualitative study from Tanzania

INTRODUCTION Globally, evidence suggests that one-third of nulliparous women experience delay in the first stage of labor with an increased risk of poor maternal and neonatal outcomes. With this study, we explore how clinical challenges related to prolonged labor are perceived by nurse-midwives and doctors in Tanzania. METHODS A qualitative study with group interviews of either nurse-midwives (7 interviews) or doctors (2 interviews). A total of 37 respondents, among them 32 registered nursemidwives and 5 doctors participated, all with experience from labor wards. A qualitative content analysis was performed. The study setting comprised one zonal consultant university hospital and one regional referral hospital in Northern Tanzania. RESULTS Clinical challenges were expressed in relation to: 1) various ways of understanding prolonged labor, manifested by variations in expected duration of labor and the usage of different terms to describe prolonged labor; 2) assessing progress in labor, the partograph being described as an important tool but also a template defining a too narrow normal; 3) appropriate intervention at the appropriate time, the respondents reflect on the correct time for artificial rupture of membranes, oxytocin augmentation and cesarean section; 4) monitoring fetal heart rate, distrust in the monitoring equipment with experiences of surprisingly poor neonates; and 5) working as a team, where the perception of urgency varies and distrust is present. CONCLUSIONS Nurse-midwives and doctors in Tanzania face major challenges related to diagnosing prolonged labor, monitoring fetal heart rate and providing high quality health services as a team

A concept map of labor progression lines demonstrating cervical dilatation over time: protocol for a systematic scoping review

The protocol for a scoping review on labor progression lines