Cephalopelvic disproportion is associated with an altered uterine contraction shape in the active phase of labor

The purpose of this study was to determine if intrapartum contractions of a particular shape (rapid rise with slower return to baseline) are predictive of cephalopelvic disproportion (CPD).

In an institutional review board (IRB)-approved study, cohorts of 100 women who underwent spontaneous vaginal delivery (SVD) and 100 who underwent cesarean section (C/S) for CPD or arrest of labor were consecutively identified between January 2004 and March 2005. Inclusion criteria included term, singleton pregnancies, nulliparity, and absence of fetal anomalies. One hour of interpretable electronic fetal monitoring (EFM) was obtained in active labor. Fall to rise (F:R) ratio was calculated by measuring the time for a contraction to return to its baseline from its peak ("fall") and the time for a contraction to rise to its peak ("rise"). The F:Rs were then averaged over the number of contractions. Data were analyzed using Student t test, Chi-square, and Fisher exact tests where appropriate.

Maternal demographics are listed in Table I. The average F:R ratio was 1.55 for SVD versus 1.77 for C/S, a statistically significant difference (P = .00003). Analysis of variance revealed this difference persists when controlled for the potentially confounding factors shown. At F:R >1.76, moreover, there was a trend towards larger birth weight (P = .06).

Our study demonstrates there is a difference in uterine contraction configuration that is more common in those labors destined for C/S due to CPD. This may indicate the presence of a heretofore unknown feedback mechanism as the uterus adapts to the dysfunctional labor.