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Original Article J Clin Med Res. 2015;7(3):150-153

Clinical Significance of Precipitous Labor

Shunji Suzuki

Abstract rapid [1-4]. Precipitous labor is extremely rapid labor and de-
livery. It is defined as expulsion of the fetus within less than
Background: Precipitous labor is defined as expulsion of the fetus 3 h of commencement of regular contractions [1]. It has been
within less than 3 hours of commencement of regular contractions. supposed to result from an abnormally low resistance of the
We retrospectively examined our cases of precipitous labor to identify soft pass of birth canal, from abnormally strong uterine and
the clinical significance and perinatal outcomes following precipitous abdominal contractions, or rarely from the absence of pain-
labor in singleton vertex deliveries. ful sensations [1]. The prevailing opinion has been that too
rapid a labor can result in maternal injury and place the fetus
Methods: A retrospective population-based study was conducted at risk for traumatic or asphyxia insults [1]. For example, the
comparing women with singleton precipitous labor and those with uterus that contracts with unusual vigor before labor may be
labor of normal duration. We examined the clinical characteristics likely to be hypotonic after delivery, with hemorrhage from the
and outcomes by comparing patients with precipitous labor and those placental implantation as the consequence. Postpartum hemor-
with labor of normal duration in 0 and two-parous singleton pregnant rhage associated with uterine atony following short labor in
women. multiparous women seems to be experienced often in the clini-
cal setting. In addition, precipitous labor has been observed to
Results: Using a multivariate analysis, precipitous labor in nullipa- be associated with the higher rate of placental abruption [2, 3].
rous women was independently associated with teenagers (adjusted However, limited information exists on maternal and perina-
OR: 1.71, 95% CI: 0.99 - 2.95, P = 0.049), preterm delivery (adjusted tal outcome after precipitous labor, especially in nulliparous
OR: 1.77, 95% CI: 1.16 - 2.70, P < 0.01) and hypertensive disorders women [2, 3]. For example, in an earlier study with 99 precipi-
(adjusted OR: 1.77, 95% CI: 1.19 - 2.65, P < 0.01), while in two-pa- tous labors at term by Mahon et al [2], precipitous labor oc-
rous women, it was independently associated with hypertensive disor- curred mostly in multiparous women. In their study, there were
ders (adjusted OR: 2.64, 95% CI: 1.33 - 5.24, P < 0.01). No significant only nine nulliparous women (9.1% of all precipitous delivery)
differences were noted between the two groups regarding maternal or with precipitous delivery.
neonatal complications on both nulliparous and two-parous women. In this study, therefore, we retrospectively examined our
cases of precipitous labor to identify the clinical significance
Conclusion: Although precipitous labor was associated with hyper- and perinatal outcome following precipitous labor.
tensive disorders in singleton vertex deliveries, it was not associated
with maternal or neonatal outcomes.
Patients and Methods
Keywords: Precipitous labor; Hypertensive disorders; Maternal out-
come
A retrospective population-based study was conducted com-
paring women with singleton precipitous labor and those with
labor of normal duration. Labor of normal duration is defined
Introduction as expulsion of the fetus with 3 - 30 h after commencement
of regular contractions in nulliparous women and 3 - 15 h af-
ter commencement of regular contractions in parous women,
Not only can labor be too slow, but it also can be abnormally while prolonged labor is defined as expulsion of the fetus more
than 30 h after commencement of regular contractions in nul-
liparous women and more than 15 h after commencement of
Manuscript accepted for publication December 12, 2014
regular contractions in parous women [5]. Deliveries in this
Department of Obstetrics and Gynecology, Japanese Red Cross Katsushika study occurred between the years 2009 and 2013 in the Japa-
Maternity Hospital, Tokyo, Japan. Email: [email protected] nese Red Cross Katsushika Maternity Hospital, one of main
Perinatal Centers in Tokyo, Japan. In our hospital, oxytocin
doi: http://dx.doi.org/10.14740/jocmr2058w has not been used in the routine for prevention of postpartum

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Suzuki J Clin Med Res. 2015;7(3):150-153

Table 1. Incidences of Precipitous and Prolonged Singleton Labors

Vaginal labor
Parity Total Cesarean delivery
Precipitate labor Normal Prolonged labor
0 5,555 386 (6.9) 3,776 (68.0) 29 (0.5) 1,364 (24.6)
1 3,880 817 (21.1) 1,844 (47.5) 48 (1.2) 1,171 (30.2)
2 1,308 320 (24.5) 590 (45.1) 8 (0.6) 390 (29.8)
≥3 496 83 (16.7) 277 (55.8) 3 (0.6) 133 (26.8)
Total 11,239 1,606 (14.3) 6,487 (57.7) 88 (0.8) 3,058 (27.2)

hemorrhage in cases of precipitous labor. Data were collected natal Apgar score at 1 and 5 min; umbilical artery pH; post-
from the patients’ charts that consist of information collected partum hemorrhage requiring hemotransfusion; perineal tears
directly after delivery by the midwives who examine the in- (severe perineal laceration: perineal laceration either third- or
formation routinely before entering it into the database. The fourth-degree laceration); and cervical tears.
following clinical characteristics and outcomes were analyzed: In this study, we examined these clinical characteristics
parity; maternal age; gestational age; birth weight; maternal and outcomes by comparing patients with precipitous labor
complications such as hypertensive diseases, glucose intoler- and those with labor of normal duration in 0 and two-parous
ance; placental abruption; oxytocin use; delivery modes; neo- women.

Table 2. Clinical Characteristics and Outcomes in Nulliparous Women With and Without Precipitate Labor

Precipitate labor Normal group P-value Crude OR 95% CI

Total 386 3776
Maternal age
   < 20 years 21 (5.4) 115 (3.0) 0.01 1.85 1.14 - 3.00
   20 - 34 years 263 (68.1) 2,670 (70.7) - Reference -
   ≥ 35 years 101 (26.2) 991 (25.2) 0.78 1.03 0.81 - 1.32
Gestational age at delivery
   < 37 weeks 53 (13.7) 159 (4.2) < 0.01 3.47 2.49 - 4.84
   37 - 40 weeks 293 (75.9) 3,050 (80.8) - Reference -
   41 - 42 weeks 40 (10.3) 563 (14.9) 0.08 0.74 0.53 - 1.04
Hypertensive disorders 36 (9.3) 174 (4.6) < 0.01 2.13 1.46 - 3.10
Glucose intolerance 10 (2.6) 87 (2.3) 0.72 1.13 0.58 - 2.19
Oxtocin use 106 (27.5) 1,353 (35.8) < 0.01 0.68 0.54 - 0.86
Placental abruption 4 (1.0) 58 (1.5) 0.44 0.67 0.24 - 1.86
Vacuum/forceps delivery 56 (14.1) 411 (12.2) 0.05 1.35 1.00 - 1.82
Neonatal birth weight
   < 2,500 g 110 (28.5) 349 (9.2) 0.01 3.64 2.84 - 4.67
   2,500 - 3,499 g 293 (75.9) 3,039 (80.5) - Reference -
   ≥ 3,500 g 40 (10.3) 388 (10.3) < 0.01 0.39 0.22 - 0.68
Apgar score at 1 min < 4 0 (0) 14 (0.4) 0.23 - -
Apgar score at 5 min < 7 1 (0.3) 7 (0.2) 0.75 1.40 0.17 - 11.40
Umbilical artery pH < 7 0 (0) 10 (0.3) 0.31 - -
Total blood loss ≥ 1,000 mL 28 (7.3) 319 (8.4) 0.42 0.85 0.57 - 1.27
Hemotransfusion 4 (1.0) 18 (0.5) 0.15 2.19 0.74 - 6.49
Cervical laceration 12 (3.1) 66 (1.3) 0.06 1.8 0.97 - 3.37
Severe perineal laceration 14 (3.6) 141 (3.7) 0.91 0.97 0.55 - 1.70
Values are expressed as number (percentage). OR: odds ratio; CI: confidence interval. Severe perineal laceration, perineal laceration either third- or
fourth-degree laceration.

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Precipitous Labor J Clin Med Res. 2015;7(3):150-153

Table 3. Clinical Characteristics and Outcomes in Two-Parous Women With and Without Precipitate Labor

Precipitate labor Normal group P-value Crude OR 95% CI

Total 320 590
Maternal age
   < 20 years 0 (0) 1 (0.2) 0.47 - -
   20 - 34 years 169 (52.8) 326 (55.3) - Reference -
   ≥ 35 years 151 (47.2) 263 (44.6) 0.46 1.11 0.84 - 1.46
Gestational age at delivery
   < 37 weeks 21 (6.6) 30 (5.1) 0.28 1.37 0.77 - 2.44
   37 - 40 weeks 261 (81.6) 511 (86.6) - Reference -
   41 - 42 weeks 38 (11.9) 49 (8.3) 0.07 1.52 0.97 - 2.38
Hypertensive disorders 30 (9.4) 15 (2.7) < 0.01 3.71 1.99 - 6.92
Glucose intolerance 10 (3.1) 15 (2.5) 0.61 1.24 0.55 - 2.79
Oxtocin use 35 (10.9) 35 (5.9) < 0.01 1.95 1.19 - 3.18
Placental abruption 4 (1.3) 4 (0.7) 0.38 1.85 0.46 - 1.47
Vacuum/forceps delivery 9 (2.8) 16 (2.7) 0.97 1.01 0.44 - 2.32
Neonatal birth weight
   < 2,500 g 28 (8.8) 42 (7.1) 0.35 1.27 0.77 - 2.10
   2,500 - 3,499 g 247 (77.2) 470 (79.7) - Reference -
   ≥ 3,500 g 45 (14.1) 48 (13.2) 0.65 1.1 0.74 - 1.63
Apgar score at 1 min < 4 0 (0) 1 (0.2) 0.46 - -
Apgar score at 5 min < 7 0 (0) 0 (0) - - -
Umbilical artery pH < 7 0 (0) 0 (0) - - -
Total blood loss ≥ 1,000 mL 17 (5.3) 32 (5.4) 0.94 0.98 0.53 - 1.79
Hemotransfusion 0 (0) 0 (0) - - -
Cervical laceration 3 (0.9) 8 (1.4) 0.58 0.69 0.18 - 2.61
Severe perineal laceration 0 (0) 3 (0.5) 0.2 - -

Values are expressed as number (percentage). OR: odds ratio; CI: confidence interval. Severe perineal laceration, perineal laceration either third- or
fourth-degree laceration.

Statistical significance was ascertained using the X2 test or two groups of nulliparous women with precipitous and normal
Fisher’s exact test for differences in qualitative variables and labor. The women with precipitate deliveries were more likely
the Student’s t-test for differences in continuous variables. A to be younger, at lower gestational age of delivery, without
multivariate logistic regression model, with backward elimi- oxytocin use, lower birth weight of infant, and hypertensive
nation, was constructed in order to find independent factors disorders as compared to those without precipitate deliveries.
associated with precipitous labor. Odds ratios (ORs) and their Using a multivariate analysis, precipitous labor was indepen-
95% confidence intervals (CIs) were computed. P < 0.05 was dently associated with teenagers (adjusted OR: 1.71, 95% CI:
considered statistically significant. 0.99 - 2.95, P = 0.049), preterm delivery (adjusted OR: 1.77,
95% CI: 1.16 - 2.70, P < 0.01) and hypertensive disorders (ad-
justed OR: 1.77, 95% CI: 1.19 - 2.65, P < 0.01). No significant
Results differences were noted between the two groups regarding ma-
ternal or neonatal complications as shown in Table 2.
During the study period, there were 11,239 singleton deliveries Table 3 shows clinical characteristics and outcomes of the
in our hospital as shown in Table 1. Of these, 1,606 (14.3%) two groups of two-parous women with precipitous and normal
were precipitous deliveries. The incidence of precipitous labor labor. The women with precipitate deliveries were more likely
in the parous women (21.5%) was significantly higher than to have oxytocin use and hypertensive disorders as compared
that in the nulliparous women (6.9%, OR: 3.66, 95% CI: 3.24 to those without precipitate deliveries. Using a multivariate
- 4.13, P < 0.01). analysis, precipitous labor was independently associated with
Table 2 shows clinical characteristics and outcomes of the hypertensive disorders (adjusted OR: 2.64, 95% CI: 1.33 -

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Suzuki J Clin Med Res. 2015;7(3):150-153

5.24, P < 0.01). No significant differences were noted between consequences of precipitous labor due to abnormally strong
the two groups regarding maternal or neonatal complications uterine contractions combined with non-dilated cervix and
as shown in Table 3. highly resistant birth canal [1, 3]. On the contrary, in this study
precipitous labor seemed to be not associated with adverse ma-
ternal outcomes. The high incidence of teenagers, small infants
Discussion and preterm delivery in the precipitous labor of this study may
contribute to the unchanged incidence of maternal complica-
The incidence of precipitous labor in this study was about 14% tions due to maternal soft birth canal and/or small fetus passing
of all singleton deliveries, which seemed to be higher than through. Otherwise, the current outcomes may be attributed to
those reported in the United States and other countries: 0.1- the different definitions of the commencement of regular con-
3% [1-3]. In Japan, the onset of labor is usually defined by the tractions between some studies.
patient’s report of the commencement of regular contractions In this study, at last, precipitous labor was not associated
of 10-min intervals. The high incidence in this study may be with maternal or neonatal outcomes. The current result sup-
attributed to the different definitions as well as the diagnosis of ports the previous observations [1-3].
regular contractions by monitoring and not patient’s report in
other countries. In this study, in addition, the incidence of pre- Conclusion
cipitous labor in the nulliparous women was higher than that
in parous women, as it is known that generally parous patients
have shorter deliveries. This result was supported by some pre- Based on the current results, although precipitous labor was
vious studies [1-3]. associated with hypertensive disorders in singleton vertex de-
In some previous studies [2, 3], one of main perinatal liveries, it was not associated with maternal or neonatal out-
complications associated with precipitous labor has been re- comes.
ported to be placental abruption, because placental abruption
can cause tachysystole, and thus shorter deliveries. On the
contrary, we did find the high incidence of placental abrup- Conflicts of Interest
tion in the women with precipitous labor. The reason leading
to the different outcomes is not clear. However, our medical Authors have no disclosures or conflicts of interest.
policy performing cesarean section immediately after the di-
agnosis of placental abruption might have attributed to reduce
the rate of vaginal delivery in cases of placental abruption [6]. References
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