Results
Between January 1 and May 31, 2019, 203 parturients were screened for
eligibility. Of these, 180 (88.7%) consenting parturients were enrolled
(figure 1). The 23 (11.3%) were ineligible due to refusal to provide
informed consent (n=12), twin gestations diagnosed during labor (n=3),
newly diagnosis of HIV/AIDS (n=2), and withdrawal of consent (6). Of
those enrolled, half (n=90) were at cervical dilation of 4 cm and the
rest (n=90) at 6 cm of cervical dilatation.
The baseline sociodemographic and reproductive health characteristics
are described in table 1. The mean age for parturients recruited at 4cm
versus 6cm was similar at 25 (SD=5) years. Similarly, education level,
employment status, parity, criteria for determination of gestation,
state of membranes, number of living children, number of Ante-Natal Care
(ANC) visits, and gestation in weeks were also comparable between the
two groups.
Maternal and neonatal outcomes are presented in table 2. More
parturients received oxytocin in the 4 cm (5) versus 6 cm (%) groups.
Administration of oxytocin was 39% statistically significantly higher
when active labor was defined at 4 cm compared to 6cm (RR 95% CI =1.39
(1.03-1.84), P=0.01). A higher proportion of parturients underwent
amniotomy in the 4 cm vs the 6cm groups. The need for amniotomy was 54%
statistically significantly greater when active labor was defined at 4cm
compared to 6cm (RR 95% CI =1.54 (1.08-2.30), P=0.01). More vaginal
examinations (VE) were performed among those recruited at 4 vs 6.
Defining active labor at 4 cm was associated with statistically
significantly higher average number of VE 4 (SD=1) compared to 6 cm 3
(SD=1), P<0.01). Although the risk of episiotomy was 18%
lower when active labor was 4 cm (17.7%) compared to 6 cm (22.2%),
this was not statistically significant. The risk of delivery via
caesarian section was 19% higher when active labor was defined at 4 cm
compared to 6 cm but this was not statistically significant P=0.308).
Similarly, the risk of primary PPH was 31% higher, perineal tears were
9% lower when active labor was defined at 4 cm compared to 6 cm and
these were not statistically significant. Neonatal outcomes when active
labor starts at 4 cm versus 6 cm, show that the APGAR scores at 5- and
10-minutes P-0.802 and 0.875, were comparable when active labor was
defined at 4 cm and 6 cm. The mean birth weight was higher when active
labor was defined at 4 cm (3355 grams (SD=417 grams) compared to 6 cm
(3310 grams (SD=464 grams). However, the results were statistically
insignificant.