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Progression of the first stage of spontaneous labour: A prospective cohort study in two sub-Saharan African countries

Overview of attention for article published in PLOS Medicine, January 2018
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  • In the top 5% of all research outputs scored by Altmetric
  • High Attention Score compared to outputs of the same age (99th percentile)
  • High Attention Score compared to outputs of the same age and source (88th percentile)

Mentioned by

news
10 news outlets
blogs
2 blogs
policy
1 policy source
twitter
271 X users
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24 Facebook pages
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2 Google+ users

Citations

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56 Dimensions

Readers on

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184 Mendeley
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Title
Progression of the first stage of spontaneous labour: A prospective cohort study in two sub-Saharan African countries
Published in
PLOS Medicine, January 2018
DOI 10.1371/journal.pmed.1002492
Pubmed ID
Authors

Olufemi T. Oladapo, Joao Paulo Souza, Bukola Fawole, Kidza Mugerwa, Gleici Perdoná, Domingos Alves, Hayala Souza, Rodrigo Reis, Livia Oliveira-Ciabati, Alexandre Maiorano, Adesina Akintan, Francis E. Alu, Lawal Oyeneyin, Amos Adebayo, Josaphat Byamugisha, Miriam Nakalembe, Hadiza A. Idris, Ola Okike, Fernando Althabe, Vanora Hundley, France Donnay, Robert Pattinson, Harshadkumar C. Sanghvi, Jen E. Jardine, Özge Tunçalp, Joshua P. Vogel, Mary Ellen Stanton, Meghan Bohren, Jun Zhang, Tina Lavender, Jerker Liljestrand, Petra ten Hoope-Bender, Matthews Mathai, Rajiv Bahl, A. Metin Gülmezoglu

Abstract

Escalation in the global rates of labour interventions, particularly cesarean section and oxytocin augmentation, has renewed interest in a better understanding of natural labour progression. Methodological advancements in statistical and computational techniques addressing the limitations of pioneer studies have led to novel findings and triggered a re-evaluation of current labour practices. As part of the World Health Organization's Better Outcomes in Labour Difficulty (BOLD) project, which aimed to develop a new labour monitoring-to-action tool, we examined the patterns of labour progression as depicted by cervical dilatation over time in a cohort of women in Nigeria and Uganda who gave birth vaginally following a spontaneous labour onset. This was a prospective, multicentre, cohort study of 5,606 women with singleton, vertex, term gestation who presented at ≤ 6 cm of cervical dilatation following a spontaneous labour onset that resulted in a vaginal birth with no adverse birth outcomes in 13 hospitals across Nigeria and Uganda. We independently applied survival analysis and multistate Markov models to estimate the duration of labour centimetre by centimetre until 10 cm and the cumulative duration of labour from the cervical dilatation at admission through 10 cm. Multistate Markov and nonlinear mixed models were separately used to construct average labour curves. All analyses were conducted according to three parity groups: parity = 0 (n = 2,166), parity = 1 (n = 1,488), and parity = 2+ (n = 1,952). We performed sensitivity analyses to assess the impact of oxytocin augmentation on labour progression by re-examining the progression patterns after excluding women with augmented labours. Labour was augmented with oxytocin in 40% of nulliparous and 28% of multiparous women. The median time to advance by 1 cm exceeded 1 hour until 5 cm was reached in both nulliparous and multiparous women. Based on a 95th percentile threshold, nulliparous women may take up to 7 hours to progress from 4 to 5 cm and over 3 hours to progress from 5 to 6 cm. Median cumulative duration of labour indicates that nulliparous women admitted at 4 cm, 5 cm, and 6 cm reached 10 cm within an expected time frame if the dilatation rate was ≥ 1 cm/hour, but their corresponding 95th percentiles show that labour could last up to 14, 11, and 9 hours, respectively. Substantial differences exist between actual plots of labour progression of individual women and the 'average labour curves' derived from study population-level data. Exclusion of women with augmented labours from the study population resulted in slightly faster labour progression patterns. Cervical dilatation during labour in the slowest-yet-normal women can progress more slowly than the widely accepted benchmark of 1 cm/hour, irrespective of parity. Interventions to expedite labour to conform to a cervical dilatation threshold of 1 cm/hour may be inappropriate, especially when applied before 5 cm in nulliparous and multiparous women. Averaged labour curves may not truly reflect the variability associated with labour progression, and their use for decision-making in labour management should be de-emphasized.

X Demographics

X Demographics

The data shown below were collected from the profiles of 271 X users who shared this research output. Click here to find out more about how the information was compiled.
Mendeley readers

Mendeley readers

The data shown below were compiled from readership statistics for 184 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 184 100%

Demographic breakdown

Readers by professional status Count As %
Student > Master 37 20%
Researcher 20 11%
Student > Bachelor 16 9%
Student > Ph. D. Student 12 7%
Other 11 6%
Other 34 18%
Unknown 54 29%
Readers by discipline Count As %
Medicine and Dentistry 58 32%
Nursing and Health Professions 26 14%
Agricultural and Biological Sciences 8 4%
Social Sciences 6 3%
Engineering 4 2%
Other 19 10%
Unknown 63 34%
Attention Score in Context

Attention Score in Context

This research output has an Altmetric Attention Score of 281. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 07 March 2023.
All research outputs
#127,166
of 25,490,562 outputs
Outputs from PLOS Medicine
#293
of 5,178 outputs
Outputs of similar age
#2,994
of 452,248 outputs
Outputs of similar age from PLOS Medicine
#7
of 53 outputs
Altmetric has tracked 25,490,562 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 99th percentile: it's in the top 5% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 5,178 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 77.6. This one has done particularly well, scoring higher than 94% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 452,248 tracked outputs that were published within six weeks on either side of this one in any source. This one has done particularly well, scoring higher than 99% of its contemporaries.
We're also able to compare this research output to 53 others from the same source and published within six weeks on either side of this one. This one has done well, scoring higher than 88% of its contemporaries.