title: Descent of the fetal head (station) during the first stage of labor.
abstract: BACKGROUND
  High station at specific points in the first stage of labor, such as a floating head on admission, or at 4-cm dilation or when arrest of dilation occurs, is associated with higher rates of failure to deliver vaginally. Therefore it could be useful to know if station is within an expected range at a given dilation during first stage. Arrest of descent disorders have been defined thus far on criteria applicable in the second stage. Statistical modeling is an attractive methodology to characterize the relationship between station and dilation because the resulting mathematical expressions could be used as a reference for comparison in the future. In addition, they can be used to produce a finely graded assessment of descent using numerical terms such as percentile rankings. A 2-step approach to potentially improving the assessment of station could be to develop a statistical model that describes the general relationship between station and dilation in the first stage of uncomplicated births and then determine if such a model would have identified births with complications related to poor labor progress. Given the complex nature of labor data, especially the imprecision of dilation and station measurement, it is not immediately evident that such a model is identifiable or what its precision would be.
  
  
  OBJECTIVE
  We sought to characterize in mathematical terms the relationship of station to dilation during the first stage of labor for nulliparous and multiparous women with spontaneous vaginal births.
  
  
  METHODS
  This retrospective cohort study included 28,121 exams from 5555 women with singleton cephalic presentations at ≥37 weeks' gestation with electronic fetal monitoring tracings, who delivered vaginally without instrumentation and had 5-minute Apgar scores >6 at 2 academic community referral hospitals in 2012 through 2013. Women with a previous cesarean birth were excluded. We used longitudinal statistical techniques suitable to biological data that were irregularly sampled with repeated measures over time.
  
  
  RESULTS
  A linear relationship was observed between station and dilation. For both nulliparous and multiparous women the final model was a linear regression with random effects for intercept and slope and a first-order autoregressive correlation structure. The 5th-95th range of station at any given dilation spanned about 3-4 cm.
  
  
  CONCLUSIONS
  Our results demonstrate a general trend of increasing descent of the presenting part as dilation advances during the first stage of labor in women who delivered vaginally without instrumentation. We propose that the mathematical expressions describing this relationship may be valuable in the assessment of first-stage labor progression.
authors.affiliation: Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada; PeriGen, Cranbury, NJ, and Westmount, Quebec, Canada. Electronic address: emily.hamilton@perigen.com.
authors.forename: Emily F
authors.initials: EF
authors.lastname: Hamilton
authors.affiliation: Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Simoneau
authors.affiliation: Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.
authors.forename: Antonio
authors.initials: A
authors.lastname: Ciampi
authors.affiliation: PeriGen, Cranbury, NJ, and Westmount, Quebec, Canada.
authors.forename: Philip
authors.initials: P
authors.lastname: Warrick
authors.affiliation: Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Collins
authors.affiliation: Department of Obstetrics and Gynecology, MedStar Franklin Square Medical Center and MedStar Harbor Hospital, Baltimore, MD.
authors.forename: Samuel
authors.initials: S
authors.lastname: Smith
authors.affiliation: PeriGen, Cranbury, NJ, and Westmount, Quebec, Canada; University of California Irvine, Orange, CA; Pediatrix Medical Group, Sunrise, FL.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Garite
mesh_terms: D000328:Adult; D003661:Decision Support Techniques; D036861:Delivery, Obstetric / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006257:Head; D006801:Humans; D007746:Labor Presentation; D007747:Labor Stage, First / Q000502:physiology*; D016014:Linear Models; D010298:Parity; D011247:Pregnancy; D012189:Retrospective Studies; D014219:Trial of Labor
keywords: fetal descent; fetal station; first stage of labor