A Novel Partogram for Stages 1 and 2 of Labor Based on Fetal Head Station Measured by Ultrasound: A Prospective Multicenter Cohort Study

Haberman, Shoshana MD, PhD
Atallah, Fouad MD
Nizard, Jacky MD, PhD
Buhule, Olive PhD
Albert, Paul PhD
Gonen, Ron MD
Ville, Yves MD
Paltieli, Yoav MD, PhD

¹Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Maimonides Medical Center, Brooklyn, New York
²Service de gynécologie obstétrique, Groupe hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, Paris, France
³National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
⁴Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Bnai Zion Medical Center, Technion, Israel Institute of Technology, Israel
⁵Department of Obstetrics and Fetal Medicine, Hôpital Necker-Enfants-Malade, Paris, France

Address for correspondence Shoshana Haberman, MD, PhD, Maimonides Medical Center—5014 Fort Hamilton Parkway, Brooklyn, NY 11219 (e-mail: [email protected]).

Conflict of interest

Y.P. was employed by Trig Medical Ltd. He also reports personal fees from Trig Medical Ltd, during the conduct of the study and outside the submitted work as well. In addition, he has a patent “Method and Apparatus for Monitoring the Progress of Labor” issued. The remaining authors report no conflict of interest.

American Journal of Perinatology 38:p e14-e20, August 2021. | DOI: 10.1055/s-0040-1702989

Abstract

Objective

This study was aimed to describe continuous labor curves, including second stage, based on fetal head station.

Study Design

We performed a prospective multicenter cohort study. The inclusion criteria were women with singleton uncomplicated cephalic term pregnancies in labor, who delivered vaginally. We used a device that combines ultrasound imaging with position-tracking technology to monitor the head station noninvasively throughout labor. We collected data on demographics, labor parameters, and delivery and neonatal outcomes.

Results

A total of 613 women delivered vaginally, 327 (53.3%) were nulliparous, while 286 (46.7%) were multiparous. Time to delivery (TTD) diminished progressively with descent of the fetal head. When the head is engaged, the labor curve of multiparous women demonstrated a more prominent downward shift in curve as compared with nulliparous women. When comparing multipara and nullipara at engagement level, the median TTD was 1 and 1.62 hours, respectively. In 95% of women with unengaged head during the second stage, TTD of nulliparous and multiparous women were less than 3.8 and 3 hours, respectively.

Conclusion

While current labor curves end at full dilatation, the described curves were developed throughout stages 1 and 2 of labor. The TTD, according to the station curves, shows an acceleration of labor, once passed the engagement level, especially in multiparous women.