Oxytocin administration during spontaneous labor: Guidelines for clinical practice. Chapter 1: Definition and characteristics of normal and abnormal labor

• Published in: Journal of gynecology obstetrics and human reproduction Vol. 46; no. 6; pp. 469 - 478
• Main Authors: Béranger, R., Chantry, A.A.
• Format: Journal Article
• Language: English
• Published: France Elsevier Masson SAS 01.06.2017; Elsevier
• Subjects: Dystocia - diagnosis; Dystocia - etiology; Female; Gynecology and obstetrics; Human health and pathology; Humans; Labor, Induced - methods; Labor, Induced - standards; Labor, Obstetric - drug effects; Labor, Obstetric - physiology; Life Sciences; Obstetric Labor Complications - diagnosis; Obstetric Labor Complications - physiopathology; Obstetrics - methods; Obstetrics - standards; Oxytocin - administration & dosage; Pharmaceutical sciences; Pharmacology; Practice Guidelines as Topic; Pregnancy; dystocia; professional guidelines; obstetric labor; pregnancy
• ISSN: 2468-7847; 2468-8495; 2468-7847
• DOI: 10.1016/j.jogoh.2017.04.011

Since the mid-1950s, the definitions of normal labor set forth by E. Friedman have guided obstetric practices in maternity units across the globe. But recent work is challenging these definitions, now considered too restrictive and thought to induce excessive interventionism by medical professionals. The objective of this chapter of these Clinical Practice Guidelines is to redefine the structure and duration of normal labor, as well as the criteria defining abnormal labor. Based on a systematic review of the literature, we make various recommendations. In the first place, the diagnosis of labor dystocia is inappropriate during the latent phase. The active phase of the first stage of labor begins at a cervical dilation between 5 and 6 cm. On the other hand, a speed of dilation < 1 cm/4 h at the beginning of the active phase of the first stage is considered abnormal, as is a speed < 1 cm/2 h above 7 cm dilation. The maximum duration of the descent phase of the second stage of labor cannot be determined from the literature, but the risk-benefit balance becomes less favorable after 3 hours. Finally, the literature does not justify any recommendation about the maximum duration of the expulsion phase. These new guidelines should make it possible to reduce the rates of oxytocin use and of cesareans for labor dystocia. Since the 1950s, Friedman's curves served as reference to guide obstetrical practice around the world. However, recent studies have suggested guidelines based on Freidman's results were too stringent and induce inappropriate and excessive interventionism. The committee aimed to redefine the structure and the normal duration of the labor, as well as the criterion to be fulfilled to consider a labor as abnormal. Several recommendations have been produced based on a systematic literature review. Labor dystocia should not be diagnosed during the latency phase. The beginning of the active phase of the 1st stage of labor has been established between 5 and 6 cm of cervical dilatation, which is later than previously suggested. Rate of cervical dilatation is considered as abnormal below 1 cm per 4 hour during the first part of the active phase, and blow 1 cm per 2 hour above 7 cm of dilatation. A maximum duration for the 2nd stage of labor cannot be defined in the French context, based on the literature. However, exceeding 3 hours, the risk-benefit balance becomes less beneficial. These new guidelines would help to reduce the use of oxytocin and caesarian delivery for labor dystocia. © 2016 Elsevier Masson SAS