title: Duration of the active phase of labor in spontaneous and induced labors.
abstract: BACKGROUND
  The aim of the study was to compare the duration of active phase of labor in women with spontaneous or induced start of labor.
  
  
  METHODS
  An observational cohort study was performed at Stavanger University Hospital in Norway between January 2010 and December 2013. During the study period 19 524 women delivered. Data for the study were collected from an electronic birth journal. Women with previous cesarean section, multiple pregnancy, breech or transverse lie, preterm labor or prelabor cesarean section were excluded. Analyses were stratified between nulliparous and parous women. Active phase of labor was defined when contractions were regular, with cervix effaced and dilated 4 cm. The main outcome measure was duration of active phase of labor.
  
  
  RESULTS
  The active phase was longer in induced labors than in labors with spontaneous onset in nulliparous women. The estimated median duration using survival analyses was 433 min (95% confidence interval 419-446) in spontaneous vs. 541 min (95% confidence interval 502-580) in induced labors [unadjusted hazard ratio 0.76 (95% confidence interval 0.71-0.82) and adjusted hazard ratio 0.88 (95% confidence interval 0.82-0.95)]. In parous women, a one minus survival plot showed that induced labors had shorter duration before six hours in active labor, but after six hours, induced labors had longer duration. The overall difference in parous women was small and probably of little clinical importance.
  
  
  CONCLUSIONS
  The active phase of labor was longer in induced than in spontaneous labors in nulliparous women.
authors.affiliation: Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway.
authors.forename: Tilde B
authors.initials: TB
authors.lastname: Østborg
authors.affiliation: Department of Public Health, NTNU, Trondheim, Norway.
authors.forename: Pål R
authors.identifier: http://orcid.org/0000-0003-2061-4336
authors.initials: PR
authors.lastname: Romundstad
authors.affiliation: Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway.|National Center for Fetal Medicine, Trondheim University Hospital (St. Olavs Hospital), Trondheim, Norway.|Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim.
authors.forename: Torbjørn M
authors.identifier: http://orcid.org/0000-0002-3162-9595
authors.initials: TM
authors.lastname: Eggebø
mesh_terms: D000328:Adult; D001724:Birth Weight; D015992:Body Mass Index; D002585:Cesarean Section; D015331:Cohort Studies; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007745:Labor Onset; D007747:Labor Stage, First; D007751:Labor, Induced / Q000706:statistics & numerical data*; D008423:Maternal Age; D009664:Norway / Q000453:epidemiology; D010298:Parity; D011247:Pregnancy; D013997:Time Factors
keywords: Labor duration; cesarean delivery; induction; nulliparous women; parous women