Labor Dystocia

Project Summary Title and Description

Labor Dystocia
Objectives: This review evaluates the comparative effectiveness of different strategies for treating labor dystocia in women with otherwise uncomplicated pregnancies. Data Sources: We searched PubMed®, Embase®, CINAHL®, and the Cochrane Database of Systematic Reviews (CDSR), limiting the searches to studies in the English-language and comparative studies published from January 1, 2005, to February 15,2019. Review Methods: Two investigators screened each abstract and full-text article for inclusion, abstracted data, rated quality and applicability, and graded evidence. When possible, random-effects models were used to compute summary estimates of effects.
Authors of Report
Methodology description
We searched PubMed®, Embase®, CINAHL®, and the Cochrane Database of Systematic Reviews (CDSR), limiting the searches to studies in the English-language and comparative studies published from January 1, 2005, to February15,2019. Two investigators screened each abstract and full-text article for inclusion, abstracted the data, and performed quality ratings and evidence grading. Random-effects models were used to compute summary estimates of effects. See the review protocol ( for full details.
This project was entered retrospectively. All Data Abstraction is available in the attached file: Labor_Data_Upload.docx
Funding Source
Agency for Healthcare Research and Quality (AHRQ)

Key Questions

1. Do delivery outcomes for management of abnormal labor differ based on the criteria used to define protracted or arrested labor at different stages of the labor process?
2. What are the benefits and harms of amniotomy in women in spontaneous labor?
3. What are the benefits and harms of supportive care measures, including ambulation, nutrition, hydration, and emotional support during spontaneous labor?
4. What are the benefits and harms of epidural analgesia in labor, particularly in terms of the risk of a diagnosis of prolonged labor?
5. How does the frequency of cervical examination affect the probability of specific benefits and harms?
6. What are the benefits and harms of intrauterine pressure catheters in the diagnosis and management of labor dystocia?
7. For women with abnormal labor, what are the relative benefits and harms of high- versus low-dose oxytocin protocols (including nipple stimulation)?
8. For women in spontaneous labor undergoing augmentation with oxytocin, what are the relative benefits and harms (in terms of both maternal and neonatal outcomes) of electronic fetal monitoring versus intermittent auscultation?
9. For women in the second stage of labor, is there a benefit from delayed or Valsalva pushing for time to delivery or mode of delivery?

Associated Extraction Forms

Associated Studies (each link opens a new tab)

Outcomes of nulliparous women with spontaneous labor onset admitted to hospitals in preactive versus active labor.-- Not Found --
Rebuilding the labor curve during neuraxial analgesia.2011
Contemporary patterns of spontaneous labor with normal neonatal outcomes.2010
Length of the first stage of labor and associated perinatal outcomes in nulliparous women.2010
"Active labor" duration and dilation rates among low-risk, nulliparous women with spontaneous labor onset: a systematic review.-- Not Found --
Evaluation of the labor curve in nulliparous Japanese women.2010
The natural history of the normal first stage of labor.2010
Does length of labor vary by maternal age?2007
Effect of different partogram action lines on birth outcomes: a randomized controlled trial.2006
Evaluation of World Health Organization partograph implementation by midwives for maternity home birth in Medan, Indonesia.2005
Applying a physiologic partograph to Consortium on Safe Labor data to identify opportunities for safely decreasing cesarean births among nulliparous women.2018
Cervical Dilatation Curves of Spontaneous Deliveries in Pregnant Japanese Females.2018
Cervical dilatation patterns of 'low-risk' women with spontaneous labour and normal perinatal outcomes: a systematic review.2018
Comparing Different Partograph Designs for Use in Standard Labor Care: A Pilot Randomized Trial.2018
Effect of partograph use on outcomes for women in spontaneous labour at term and their babies.2018
Likelihood of cesarean delivery after applying leading active labor diagnostic guidelines.2017
Optimal Admission Cervical Dilation in Spontaneously Laboring Women.2016
Cervical Dilation on Admission in Term Spontaneous Labor and Maternal and Newborn Outcomes.2016
Labor Curves in Multiparous Women Related to Interbirth Intervals.2018
Management of Spontaneous Labor in Primigravidae: Labor Scale versus WHO Partograph (SLiP Trial) Randomized Controlled Trial.2018
Oxytocin administration during spontaneous labor: Guidelines for clinical practice. Chapter 1: Definition and characteristics of normal and abnormal labor.
Duration of spontaneous labour in 'low-risk' women with 'normal' perinatal outcomes: A systematic review.2018
Package of care for active management in labour for reducing caesarean section rates in low-risk women.2013
Effect of early amniotomy on dystocia risk and cesarean delivery in nulliparous women: a randomized clinical trial.2015
Early amniotomy and early oxytocin for prevention of, or therapy for, delay in first stage spontaneous labour compared with routine care.
Amniotomy for shortening spontaneous labour.
A trial of amniotomy in a Palestinian hospital.2007
The effect of amniotomy on the outcome of spontaneous labour in uncomplicated pregnancy.2006
Effect of early amniotomy on the outcome of spontaneous labour: a randomized controlled trial of pregnant women in Enugu, South-east Nigeria.2015
The Effect of Early Versus Late Amniotomy on The Course of Labor.2017
Randomized controlled trial of the effect of amniotomy on the duration of spontaneous labor.2017
Effects of amniotomy versus spontaneous rupture of membrane on progress of labour and foetal outcome in primigravidae.2010
Comparison of the Effects of Maternal Supportive Care and Acupressure (at BL32 Acupoint) on Labor Length and Infant's Apgar Score.2015
Routine labour epidural analgesia versus labour analgesia on request: a randomised non-inferiority trial.2015
Combined spinal and epidural anaesthesia and maternal intrapartum temperature during vaginal delivery: a randomized clinical trial.2011
Effect of combined spinal-epidural analgesia versus epidural analgesia on labor and delivery duration.2011
Ambulation in labour and delivery mode: a randomised controlled trial of high-dose vs mobile epidural analgesia.2009
Early versus delayed oxytocin augmentation in nulliparous women with prolonged labour--a randomised controlled trial.2009
Comparison of the maternal experience and duration of labour in two upright delivery positions--a randomised controlled trial.2006
A randomized trial of coached versus uncoached maternal pushing during the second stage of labor.2006
Randomized, double-blinded, controlled trial comparing parenteral dextrose 5%, Ringer’s solution and oral intake on the delivery outcomes in Nulliparas2017
Duration of Spontaneous Active Labor and Perinatal Outcomes Using Contemporary Labor Curves.2018
The expected labor progression after labor augmentation with oxytocin: A retrospective cohort study.
Comparison between amniotomy, oxytocin or both for augmentation of labor in prolonged latent phase: a randomized controlled trial.2010
Reducing cesarean delivery rates: an active management labor program in a setting with limited resources.2005
Effect of direct current pulse stimulating acupoints of JiaJi (T10-13) and Ciliao (BL 32) with Han's Acupoint Nerve Stimulator on labour pain in women: a randomized controlled clinical study.2015
Effects of electroacupuncture on reducing labor pain and complications in the labor analgesia process of combined spinal-epidural analgesia with patient-controlled epidural analgesia.2019
Effectiveness of acupuncture versus spinal-epidural anesthesia on labor pain: a randomized controlled trial. 2017
Effects of LI-4 and SP-6 Acupuncture on Labor Pain, Cortisol Level and Duration of Labor.2015
Comparing the impact of acupuncture and pethidine on reducing labor pain.2015
Comparison of the effect of aromatherapy with Jasminum officinale and Salvia officinale on pain severity and labor outcome in nulliparous women.2014
Acupuncture with manual and electrical stimulation for labour pain: a longitudinal randomised controlled trial.2014
Maternal positions and mobility during first stage labour.2013
Restricting oral fluid and food intake during labour.
Effectiveness of semi sitting position during 2nd stage of labour on maternal and neonatal outcomes among primigravida.-- Not Found --
Effect of hydration on spontaneous labor outcomes in nulliparous pregnant women: a multicenter randomized controlled trial comparing three methods.2014
Intravenous fluids for reducing the duration of labour in low risk nulliparous women.
Massage reduced severity of pain during labour: a randomised trial.2013
Massage therapy and labor outcomes: a randomized controlled trial.2012
Effect of oral carbohydrate intake on labor progress: randomized controlled trial.2012
Labour augmentation and fetal outcomes in relation to birth positions: a secondary analysis of an RCT evaluating birth seat births.2013
A randomized controlled trial comparing parenteral normal saline with and without 5% dextrose on the course of labor in nulliparous women.
Increased intravenous hydration of nulliparas in labor.2012
Effects of LI4 acupressure on labor pain in the first stage of labor.-- Not Found --
Effects of massage therapy and presence of attendant on pain, anxiety and satisfaction during labor.2012
A randomized controlled trial to study the effect of IV hydration on the duration of labor in nulliparous women.2012
Acupuncture or acupressure for pain management in labour.2011
Effect of birth ball usage on pain in the active phase of labor: a randomized controlled trial.-- Not Found --
Effects of Sanyinjiao (SP6) with electroacupuncture on labour pain in women during labour.2011
A randomized trial of increased intravenous hydration in labor when oral fluid is unrestricted.2010
Experience of water birth delivery in Iran.2009
Immersion in water in labour and birth.2009
A randomized, double-blinded, controlled trial comparing parenteral normal saline with and without dextrose on the course of labor in nulliparas.2009
A randomized controlled trial of continuous labor support for middle-class couples: effect on cesarean delivery rates.2008
Upright position during the first stage of labor: a randomised controlled trial.2007
Child birth in squatting position.2007
Maternal position during the first stage of labor: a systematic review.2006
Increased intravenous fluid intake and the course of labor in nulliparous women.2006
Midwifery care measures in the second stage of labor and reduction of genital tract trauma at birth: a randomized trial.-- Not Found --
Effects of labor support from close female relative on labor and maternal satisfaction in a Thai setting.2012
Assessment and support during early labour for improving birth outcomes.2017
Birth ball or heat therapy? A randomized controlled trial to compare the effectiveness of birth ball usage with sacrum-perineal heat therapy in labor pain management.
Continuous support for women during childbirth.2017
Does oral carbohydrate supplementation improve labour outcome? A systematic review and individual patient data meta-analysis.2016
The effect of aromatherapy with lavender essence on severity of labor pain and duration of labor in primiparous women.2016
Effect of Massage Therapy on Duration of Labour: A Randomized Controlled Trial.2016
Efficacy of aromatherapy for reducing pain during labor: a randomized controlled trial.2018
The influence of different maternal pushing positions on birth outcomes at the second stage of labor in nulliparous women.2017
Intravenous fluid rate for reduction of cesarean delivery rate in nulliparous women: a systematic review and meta-analysis.2017
Perineal massage during labor: a systematic review and meta-analysis of randomized controlled trials.2018
A Prospective Randomized Trial of Postural Changes vs Passive Supine Lying during the Second Stage of Labor under Epidural Analgesia.2017
A randomised controlled trial in comparing maternal and neonatal outcomes between hands-and-knees delivery position and supine position in China.2017
A randomized, double-blinded, controlled trial of the effects of fluid rate and/or presence of dextrose in intravenous fluids on the labor course of nulliparas.2017
Sequential application of non-pharmacological interventions reduces the severity of labour pain, delays use of pharmacological analgesia, and improves some obstetric outcomes: a randomised trial.2018
Upright versus lying down position in second stage of labour in nulliparous women with low dose epidural: BUMPES randomised controlled trial.2017
Support to woman by a companion of her choice during childbirth: a randomized controlled trial.2007
Perineal outcomes and maternal comfort related to the application of perineal warm packs in the second stage of labor: a randomized controlled trial.2007
Effects of acupressure at the Sanyinjiao point (SP6) on the process of active phase of labor in nulliparas women.2009
Continuous support for women during childbirth.2013
The influence of cold pack on labour pain relief and birth outcomes: a randomised controlled trial.2014
A randomized clinical trial of the efficacy of applying a simple protocol of boiled Anethum Graveolens seeds on pain intensity and duration of labor stages.2014
Reducing Length of Labor and Cesarean Surgery Rate Using a Peanut Ball for Women Laboring With an Epidural.2015
Less-Restrictive Food Intake During Labor in Low-Risk Singleton Pregnancies: A Systematic Review and Meta-analysis.2017
The Effects of Intrapartum Supportive Care on Fear of Delivery and Labor Outcomes: A Single-Blind Randomized Controlled Trial.2017
A randomized controlled trial of a new treatment for labor dystocia.2018
The effect of transcutaneous electrical nerve stimulation on the severity of labor pain among nulliparous women: A clinical trial.2017
Doula support compared with standard care: Meta-analysis of the effects on the rate of medical interventions during labour for low-risk women delivering at term. 2015
Mobility is an adjuvant approach for intrapartum care - A clinical randomized interventional study.2014
Effectiveness of Ambulation during First Stage of Labour, on the Outcome of Labour among Primigravid Women in Selected Hospitals of Palakkad District, Kerala.2015
The effect of lavender aromatherapy on pain perception and intrapartum outcome in primiparous women2014
Effect of the Prince of Songkla University Birthing Bed on Duration, Pain, and Comfort Level during Second-Stage Labor in Primiparous Thais.2013
Childbirth in Supported Sitting Maternal Position.2012
The effects of the PSU Cat position and music on length of time in the active phase of labor and labor pain.2007
Effect of Acupressure on Labor Pain and Duration of Delivery among Laboring Women Attending Cairo University Hospital.2013
Comparing the effects of hot shower and intravenous injection of hyoscine on the pain intensity and duration of active phase of labour in nulliparous women. 2018
Comparison of Entonox and Transcutaneous Electrical Nerve Stim-ulation (TENS) in labor pain.2017
Effect of water immersion on labor outcomes: A randomized clinical trial.2018
Does bupivacaine and fentanyl combination for epidural analgesia shorten the duration of labour?2015
Fetal effects of combined spinal-epidural vs epidural labour analgesia: a prospective, randomised double-blind study.2014
A comparison of remifentanil parturient-controlled intravenous analgesia with epidural analgesia: a meta-analysis of randomized controlled trials.2014
Neuraxial analgesia versus intravenous remifentanil for pain relief in early labor in nulliparous women.2012
Labour analgesia: a randomised, controlled trial comparing intravenous remifentanil and epidural analgesia with ropivacaine and fentanyl.2012
Regional versus IV analgesics in labor.2011
Epidural versus non-epidural or no analgesia in labour.2011
A randomised comparison of intravenous remifentanil patient-controlled analgesia with epidural ropivacaine/sufentanil during labour.2011
Effects on mother and fetus of epidural and combined spinal-epidural techniques for labor analgesia.-- Not Found --
Elevation of uterine basal tone and fetal heart rate abnormalities after labor analgesia: a randomized controlled trial.
Efficacy of patient-controlled epidural analgesia after initiation with epidural or combined spinal-epidural analgesia.2007
Patient-requested neuraxial analgesia for labor: impact on rates of cesarean and instrumental vaginal delivery.2007
Effects of epidural lidocaine analgesia on labor and delivery: a randomized, prospective, controlled trial.2006
Early versus late initiation of epidural analgesia in labor: does it increase the risk of cesarean section? A randomized trial.2006
The risk of cesarean delivery with neuraxial analgesia given early versus late in labor.2005
A comparison between epidural and IV tramadol for painless labor and effect on perinatal outcome.2011
Comparison of combined spinal epidural technique and low dose epidural technique in progress of labour.2008
Epidural Analgesia During the Second Stage of Labor: A Randomized Controlled Trial.2017
Routine vaginal examinations for assessing progress of labour to improve outcomes for women and babies at term.
Internal versus external tocodynamometry during induced or augmented labour.2013
High-dose versus low-dose oxytocin for augmentation of delayed labour.2013
Oxytocin versus no treatment or delayed treatment for slow progress in the first stage of spontaneous labour.2013
Standard- or high-dose oxytocin for nulliparous women with confirmed delay in labour: quantitative and qualitative results from a pilot randomised controlled trial.2013
Oxytocin augmentation of labour in women with epidural analgesia for reducing operative deliveries.2012
Pulsatile versus continuous administration of oxytocin for induction and augmentation of labor: two randomized controlled trials.2012
High-dose vs low-dose oxytocin for labor augmentation: a systematic review.2010
The effect of early oxytocin augmentation in labor: a meta-analysis.2009
A randomised controlled trial of early versus delayed oxytocin augmentation to treat primary dysfunctional labour in nulliparous women.2008
A double blind, randomized trial on augmentation of labour with a combination of intravenous propranolol and oxytocin versus oxytocin only.2006
Accelerated Titration of Oxytocin in Nulliparous Women with Labour Dystocia: Results of the ACTION Pilot Randomized Controlled Trial.2018
Effects of Increased Frequency, High Dose, and Pulsatile Oxytocin Regimens on Abnormal Labor Delivery.2018
Oxytocin administration during spontaneous labor: Guidelines for clinical practice. Chapter 2: Indications of oxytocin according the first and second stages of spontaneous labor.2017
High-dose versus low-dose of oxytocin for labour augmentation: a randomised controlled trial.2019
Low-dose versus high-dose oxytocin in augmentation of labor: A prospective study.2015
Intermittent auscultation (IA) of fetal heart rate in labour for fetal well-being.2017
Effects of pushing techniques in birth on mother and fetus: a randomized study.2008
Do maternal pushing techniques during labour affect obstetric or neonatal outcomes?2016
Effects of pushing techniques during the second stage of labor: A randomized controlled trial.2017
Pushing/bearing down methods for the second stage of labour.2017
Spontaneous Pushing in Lateral Position versus Valsalva Maneuver During Second Stage of Labor on Maternal and Fetal Outcomes: A Randomized Clinical Trial.2016
Effect of Immediate vs Delayed Pushing on Rates of Spontaneous Vaginal Delivery Among Nulliparous Women Receiving Neuraxial Analgesia: A Randomized Clinical Trial.2018

Downloadable Data Content

  • XLSX Project Data