Progression of the first stage of spontaneous labour: A prospective cohort study in two sub-Saharan African countries.

BACKGROUND: Escalation in the global rates of labour interventions, particularly cesarean section and oxytocin augmentation, has renewed interest in a better understanding of natural labour progression. Methodological advancements in statistical and computational techniques addressing the limitations of pioneer studies have led to novel findings and triggered a re-evaluation of current labour practices. As part of the World Health Organization's Better Outcomes in Labour Difficulty (BOLD) project, which aimed to develop a new labour monitoring-to-action tool, we examined the patterns of labour progression as depicted by cervical dilatation over time in a cohort of women in Nigeria and Uganda who gave birth vaginally following a spontaneous labour onset. METHODS AND FINDINGS: This was a prospective, multicentre, cohort study of 5,606 women with singleton, vertex, term gestation who presented at ≤ 6 cm of cervical dilatation following a spontaneous labour onset that resulted in a vaginal birth with no adverse birth outcomes in 13 hospitals across Nigeria and Uganda. We independently applied survival analysis and multistate Markov models to estimate the duration of labour centimetre by centimetre until 10 cm and the cumulative duration of labour from the cervical dilatation at admission through 10 cm. Multistate Markov and nonlinear mixed models were separately used to construct average labour curves. All analyses were conducted according to three parity groups: parity = 0 (n = 2,166), parity = 1 (n = 1,488), and parity = 2+ (n = 1,952). We performed sensitivity analyses to assess the impact of oxytocin augmentation on labour progression by re-examining the progression patterns after excluding women with augmented labours. Labour was augmented with oxytocin in 40% of nulliparous and 28% of multiparous women. The median time to advance by 1 cm exceeded 1 hour until 5 cm was reached in both nulliparous and multiparous women. Based on a 95th percentile threshold, nulliparous women may take up to 7 hours to progress from 4 to 5 cm and over 3 hours to progress from 5 to 6 cm. Median cumulative duration of labour indicates that nulliparous women admitted at 4 cm, 5 cm, and 6 cm reached 10 cm within an expected time frame if the dilatation rate was ≥ 1 cm/hour, but their corresponding 95th percentiles show that labour could last up to 14, 11, and 9 hours, respectively. Substantial differences exist between actual plots of labour progression of individual women and the 'average labour curves' derived from study population-level data. Exclusion of women with augmented labours from the study population resulted in slightly faster labour progression patterns. CONCLUSIONS: Cervical dilatation during labour in the slowest-yet-normal women can progress more slowly than the widely accepted benchmark of 1 cm/hour, irrespective of parity. Interventions to expedite labour to conform to a cervical dilatation threshold of 1 cm/hour may be inappropriate, especially when applied before 5 cm in nulliparous and multiparous women. Averaged labour curves may not truly reflect the variability associated with labour progression, and their use for decision-making in labour management should be de-emphasized

Sexismo científico: o viés de gênero na produção científica da Universidade de São Paulo

OBJETIVO Investigar desigualdades de gênero na produção científica de docentes da Universidade de São Paulo. MÉTODOS A população consiste em professores(as) da Universidade de São Paulo. O repositório Web of Science foi a fonte das métricas de publicação. Selecionamos as medidas: total de publicações e citações, média de citações por ano e por item, índice H e histórico de citações entre 1950 e 2019. Usamos o nome do(a) docente como um proxy para a identidade de gênero. Usamos estatísticas descritivas para caracterizar as métricas. Avaliamos o efeito tesoura selecionando os(as) professores(as) com índice H alto. A série histórica de citações foi projetada até 2100. Realizamos análises para a população geral e subgrupos de tempo de trabalho: menos de 10 anos, de 10 a 20 anos e 20 anos ou mais. RESULTADOS Dos 8.325 docentes, incluímos 3.067 (36,8%). Dentre os incluídos, 1.893 (61,7%) eram professores e 1.174 (38,28%) professoras. O gênero masculino apresentou valores mais altos nas métricas de publicação (média de artigos: M = 67,0 versus F = 49,7; média de citações/ano: M = 53,9 versus F = 35,9) e índice H (M = 14,5 versus F = 12,4). Entre os 100 indivíduos com maior índice H (≥ 37), 83% são do gênero masculino. Na série histórica de citações, a curva masculina cresce mais rápido, abrindo uma diferença entre os grupos com afastamento confirmado pela projeção. DISCUSSÃO A produção científica na Universidade de São Paulo está sujeita a um viés de gênero. Dois terços do corpo docente são do gênero masculino, e as contratações das últimas décadas perpetuam esse padrão. A grande maioria dos membros com alto impacto no corpo docente é do sexo masculino. CONCLUSÃO Nossas análises sugerem que a Universidade de São Paulo não superará a desigualdade de gênero na produção científica sem uma ação afirmativa substancial. O desenvolvimento não acontece por acaso, mas por meio de escolhas afirmativas, decisivas e de longo prazo.OBJECTIVE To investigate gender inequity in the scientific production of the University of Sao Paulo. METHODS Members of the University of Sao Paulo faculty are the study population. The Web of Science repository was the source of the publication metrics. We selected the measures: total publications and citations, average of citations per year and item, H-index, and history of citations between 1950 and 2019. We used the name of the faculty member as a proxy to the gender identity. We use descriptive statistics to characterize the metrics. We evaluated the scissors effect by selecting faculty members with a high H-index. The historical series of citations was projected until 2100. We carry out analyses for the general population and working time subgroups: less than 10 years, 10 to 20 years, and 20 years or more. RESULTS Of the 8,325 faculty members, we included 3,067 (36.8%). Among those included, 1,893 (61.7%) were male and 1,174 (38.28%) female. The male gender presented higher values in the publication metrics (average of articles: M = 67.0 versus F = 49.7; average of citations/year: M = 53.9 versus F = 35.9), and H-index (M = 14.5 versus F = 12.4). Among the 100 individuals with the highest H-index (≥ 37), 83% are male. The male curve grows faster in the historical series of citations, opening a difference between the groups whose separation is confirmed by the projection. DISCUSSION Scientific production at the Universidade de São Paulo is subject to a gender bias. Two-thirds of the faculty are male, and hiring over the past few decades perpetuates this pattern. The large majority of high impact faculty members are male. CONCLUSION Our analysis suggests that the Universidade de São Paulo will not overcome gender inequality in scientific production without substantive affirmative action. Development does not happen by chance but through choices that are affirmative, decisive, and long-term oriented

Duration of labour from one level of cervical dilatation to the next by parity and analysis method.

<p>Duration of labour from one level of cervical dilatation to the next by parity and analysis method.</p

The 95th percentiles of cumulative duration of labour in parity = 2+ women by augmentation.

<p>(A) Survival analysis. (B) Multistate Markov analysis. Thin lines: all women. Thick lines: women with oxytocin augmentation excluded.</p

Average labour curves by parity based on multistate Markov models.

<p>P0, nulliparous women; P1, parity = 1 women; P2+, parity = 2+ women.</p

The 95th percentiles of cumulative duration of labour in parity = 1 women by augmentation.

<p>(A) Survival analysis. (B) Multistate Markov analysis. Thin lines: all women. Thick lines: women with oxytocin augmentation excluded.</p

The 95th percentiles of cumulative duration of labour in nulliparous women by augmentation.

<p>(A) Survival analysis. (B) Multistate Markov analysis. Thin lines: all women. Thick lines: women with oxytocin augmentation excluded.</p

Labour characteristics and interventions by parity.

<p>Labour characteristics and interventions by parity.</p