OBSTETRIC OUTCOMES AMONG LOW RISK PARTURIENTS WHEN ACTIVE PHASE OF LABOR IS DEFINED AT A CERVICAL DILATATION OF 6 VERSUS 4 CENTIMETRES AT KENYATTA NATIONAL HOSPITAL, KENYA

Background: Neal et al. suggested that active labor started at 6 centimeters (cm) cervical dilatation which differs from Friedman’s labor curve of 4cm. The feasibility and risk of adverse obstetric outcomes when active labor starts at 4cm compared to 6cm dilatation has not been studied amongst African women. Objective: Compare incidences of adverse obstetric outcomes among low-risk parturients when active labor starts at 6cm versus 4cm dilatation. Methodology:180 low-risk parturients in spontaneous labor between 37-42 weeks gestation with a singleton fetus in cephalic presentation and reassuring fetal status were recruited, allotted to 4 cm or 6 cm arms and intrapartum and immediate postpartum outcomes recorded. Demographic characteristics were summarized and Chi-square tests used to evaluate relationships between study arms. P-value was considered significant at <0.05 at the 95% level of confidence. Results: Between January and April 2019, 90 parturients each were recruited to the 4cm and 6cm arms. Demographic and reproductive characteristics were comparable on admission. Defining active labor at cervical dilatation of 4 cm versus 6 cm was not associated with adverse maternal and neonatal outcomes. However, the need for amniotomy and oxytocin was 1.44 (1.09-1.96) and 1.42 (1.07-1.88) times higher when active labor was defined as cervical dilation of 4 cm than 6 cm (P<0.05). Conclusion: Defining active labor at cervical dilatation of 4 cm versus 6 cm was not linked with adverse obstetric outcomes. However, defining active labor at 4 cm than 6 cm increased the risk of amniotomy and oxytocin administration 1.44 and 1.42-fold.