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Obstetrics & Gynecology 2007;110:566-569
© 2007 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Uterine Contractions Preceding Labor

Jason A. Pates, MD1, Donald D. McIntire, PhD1 and Kenneth J. Leveno, MD1

From the 1Department of Obstetrics and Gynecology, the University of Texas Southwestern Medical Center at Dallas, Dallas, Texas.

OBJECTIVE: To evaluate whether 12 contractions in 1 hour is a meaningful signal that spontaneous labor has begun or is imminent.

METHODS: This prospective observational cohort study includes all women reporting contractions who presented to a labor and delivery triage unit between August 1 and October 31, 2006, who met the following criteria: 1) 36 0/7 to 41 6/7 weeks of gestation, 2) cervical dilation less than 4 cm, 3) intact membranes, and 4) no other medical or obstetric complications that might influence admission. Each woman received external fetal monitoring for a minimum of 1 hour. Women were discharged home if cervical dilation did not advance and the fetal heart rate pattern was reassuring. Women who progressed to a cervical dilation of 4 cm were admitted with the diagnosis of labor.

RESULTS: Among 768 women studied, labor was diagnosed within 24 hours in 268 (76%) with 12 or more contractions per hour compared with 216 (52%) of 416 women with fewer than 12 contractions per hour, P<.001. Cervical condition and fetal station were more advanced on presentation in women with 12 or more contractions per hour.

CONCLUSION: Twelve contractions or more per hour at term is a meaningful signal that true labor has either begun or is imminent.

LEVEL OF EVIDENCE: II






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