ArticleObstetrics and gynecology2010
The natural history of the normal first stage of labor.
Article in Obstetrics and gynecology, 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 64 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
64 citing papers in PubMed, 4 syntheses or guidelines pooled it, 290 citations in OpenAlex.
- Optimizing labor duration with pilates: evidence from a systematic review and meta-analysis of randomized controlled trials.BMC pregnancy and childbirth · 2024Pooled it
- Cervical dilatation patterns of 'low-risk' women with spontaneous labour and normal perinatal outcomes: a systematic review.BJOG : an international journal of obstetrics and gynaecology · 2018Pooled it
- Duration of spontaneous labour in 'low-risk' women with 'normal' perinatal outcomes: A systematic review.European journal of obstetrics, gynecology, and reproductive biology · 2018Pooled it
- Diagnosing onset of labor: a systematic review of definitions in the research literature.BMC pregnancy and childbirth · 2016Pooled it
- Factors Predicting Successful Vaginal Delivery Following Induction of Labor in Term Pregnancy.International journal of women's health · 2022Trial
- De-medicalization of birth by reducing the use of oxytocin for augmentation among first-time mothers - a prospective intervention study.BMC pregnancy and childbirth · 2018Trial
- Study protocol: the Labor Progression Study, LAPS - does the use of a dynamic progression guideline in labor reduce the rate of intrapartum cesarean sections in nulliparous women? A multicenter, cluster randomized trial in Norway.BMC pregnancy and childbirth · 2017Trial
- Impact of active phase duration on neonatal and maternal adverse outcomes: A systematic analysis of parity stratification, body mass index interaction, and predictive modeling in a retrospective cohort.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2026Article
- Time from pre-labor rupture of membrane at term to delivery in grand multiparous women.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2026Article
- An Appraisal of Labor Augmentation: An Update on Current Evidence and Practice.Maternal-fetal medicine (Wolters Kluwer Health, Inc.) · 2026Review
- Article
- Disparities in Pain Evaluation and Treatment During Labor: A Racial and Ethnic Perspective.Journal of clinical medicine · 2025Article
- Administering intrathecal sufentanil during the second stage of labor: impact on duration.Annals of medicine and surgery (2012) · 2025Article
- Physiological plateaus during normal labor and birth: A novel definition.Birth (Berkeley, Calif.) · 2025Article
- Article
- New labor curves of dilation and station to improve the accuracy of predicting labor progress.American journal of obstetrics and gynecology · 2024Article
- Labor curves based on cervical dilatation over time and their accuracy and effectiveness: A systematic scoping review.PloS one · 2024Article
- Labor patterns of spontaneous first-stage labor in Chinese women with normal neonatal outcomes.PloS one · 2024Observational
- The evolution of the labor curve and its implications for clinical practice: the relationship between cervical dilation, station, and time during labor.American journal of obstetrics and gynecology · 2023Review
- Latent phase duration and associated outcomes: a contemporary, population-based observational study.American journal of obstetrics and gynecology · 2023Observational
4 more citing papers are in PubMed but not listed here.
Corrections and comments
- Commented on by
- Commented on by
- Commented on by
- Erratum issued
Authors and funding
6 authors at 1 institution in 1 country.
Funding
Abstract
objectiveTo examine labor patterns in a large population and to explore an alternative approach for diagnosing abnormal labor progression.
methodsData from the National Collaborative Perinatal Project were used. A total of 26,838 parturients were selected who had a singleton term gestation, spontaneous onset of labor, vertex presentation, and a normal perinatal outcome. A repeated-measures analysis was used to construct average labor curves by parity. An interval-censored regression was used to estimate duration of labor stratified by cervical dilation at admission and centimeter by centimeter.
resultsThe median time needed to progress from one centimeter to the next became shorter as labor advanced (eg, from 1.2 hours at 3-4 cm to 0.4 hours at 7-8 cm in nulliparas). Nulliparous women had the longest and most gradual labor curve; multiparous women of different parities had very similar curves. Nulliparas may start the active phase after 5 cm of cervical dilation and may not necessarily have a clear active phase characterized by precipitous dilation. The deceleration phase in the late active phase of labor may be an artifact in many cases.
conclusionThe active phase of labor may not start until 5 cm of cervical dilation in multiparas and even later in nulliparas. A 2-hour threshold for diagnosing labor arrest may be too short before 6 cm of dilation, whereas a 4-hour limit may be too long after 6 cm. Given that cervical dilation accelerates as labor advances, a graduated approach based on levels of cervical dilation to diagnose labor protraction and arrest is proposed. LEVEL OF EVIDENCE: III.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.