Labour management: an appraisal of the role of false labour and latent phase on the delivery mode.

摘要

Achieving normal vaginal delivery requires an orderly transition from early labour to an established active labour. We analysed retrospectively the outcome of labour and the delivery mode based on the diagnosis of labour from the first examination of 3,130 parturients. A total of 1,847 (59.1%) delivered mothers had the first vaginal examination performed by the senior house officer (SHO). The majority (74.4%) of the mothers presented in established labour (cervical dilatation > or =4 cm), 25.6% in early labour, while 11.3% in latent phase. Patients who presented in established labour had a statistically significant higher spontaneous vertex delivery (SVD) rate (Pearson chi2 = 29.74, p = 0.000). A total of 62 parturients (17.5%) who presented in the latent phase and 204 (29.1%) in early labour had an unfavourable delivery mode; 46 had a caesarean section. There was a significant correlation between delivery mode and prolonged latent phase (Pearson correlation coefficient R = -0.066, p = 0.000). Linear regression analysis showed that the total number of VEs was the most significant predictor of the delivery mode of SVD (Regression beta-coefficient = 0.278, t = 10.37, p = 0.000). Early admissions in labour and a prolonged (abnormal) latent phase are significant predictors of difficult mode of delivery (poor labour outcome). We suggest that the first vaginal examination should be undertaken by the most experienced medical personal present at admission.