Partogram of Grandmultiparous Parturients: A Multicenter Cohort Study

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Labor and Delivery Research

Background:

• Limited data exists on the normal labor progression for grand-multiparous (GMP) women (parity 6+).
• Customized labor management for GMPs might reduce cesarean delivery rates for protraction disorders.
• Understanding GMP labor curves is crucial for optimizing obstetric care.

Purpose of the Study:

• To establish a normal labor curve for GMP parturients.
• To compare the labor progression of GMP women with multiparous (MP) women (parity 2-5).
• To inform clinical practice regarding the use of standard partograms for GMPs.

Main Methods:

• Multicenter retrospective cohort analysis of deliveries from 2003-2019.
• Inclusion of singleton, cephalic presentations at ≥37 weeks with at least two cervical examinations.
• Comparison of labor parameters between GMP (study group) and MP (control group) parturients.

Main Results:

• Cervical dilation in the first stage of labor was similar between GMP and MP groups.
• Fetal head descent was slightly faster in GMPs compared to MPs, irrespective of epidural anesthesia.
• The second stage of labor was significantly shorter in GMPs (95th percentile: 48 min) than in MPs (95th percentile: 91 min).

Conclusions:

• Grand-multiparous and multiparous women exhibit similar cervical dilation rates during the active phase of labor.
• The second stage of labor is notably shorter in grand-multiparous women, even with epidural use.
• Standard labor partograms for the active phase are appropriate for managing grand-multiparous parturients.