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150
Original Article
J Clin Med Res. 2015;7(3):150-153
ress
Elmer
Clinical Signicance of Precipitous Labor
Shunji Suzuki
Abstract
Background: Precipitous labor is dened as expulsion of the fetus
within less than 3 hours of commencement of regular contractions.
We retrospectively examined our cases of precipitous labor to identify
the clinical signicance and perinatal outcomes following precipitous
labor in singleton vertex deliveries.
Methods: A retrospective population-based study was conducted
comparing women with singleton precipitous labor and those with
labor of normal duration. We examined the clinical characteristics
and outcomes by comparing patients with precipitous labor and those
with labor of normal duration in 0 and two-parous singleton pregnant
women.
Results: Using a multivariate analysis, precipitous labor in nullipa-
rous women was independently associated with teenagers (adjusted
OR: 1.71, 95% CI: 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
(adjusted OR: 1.77, 95% CI: 1.19 - 2.65, P < 0.01), while in two-pa-
rous women, it was independently associated with hypertensive disor-
ders (adjusted OR: 2.64, 95% CI: 1.33 - 5.24, P < 0.01). No signicant
differences were noted between the two groups regarding maternal or
neonatal complications on both nulliparous and two-parous women.
Conclusion: Although precipitous labor was associated with hyper-
tensive disorders in singleton vertex deliveries, it was not associated
with maternal or neonatal outcomes.
Keywords: Precipitous labor; Hypertensive disorders; Maternal out-
come
Introduction
Not only can labor be too slow, but it also can be abnormally
rapid [1-4]. Precipitous labor is extremely rapid labor and de-
livery. It is dened as expulsion of the fetus within less than
3 h of commencement of regular contractions [1]. It has been
supposed to result from an abnormally low resistance of the
soft pass of birth canal, from abnormally strong uterine and
abdominal contractions, or rarely from the absence of pain-
ful sensations [1]. The prevailing opinion has been that too
rapid a labor can result in maternal injury and place the fetus
at risk for traumatic or asphyxia insults [1]. For example, the
uterus that contracts with unusual vigor before labor may be
likely to be hypotonic after delivery, with hemorrhage from the
placental implantation as the consequence. Postpartum hemor-
rhage associated with uterine atony following short labor in
multiparous women seems to be experienced often in the clini-
cal setting. In addition, precipitous labor has been observed to
be associated with the higher rate of placental abruption [2, 3].
However, limited information exists on maternal and perina-
tal outcome after precipitous labor, especially in nulliparous
women [2, 3]. For example, in an earlier study with 99 precipi-
tous labors at term by Mahon et al [2], precipitous labor oc-
curred mostly in multiparous women. In their study, there were
only nine nulliparous women (9.1% of all precipitous delivery)
with precipitous delivery.
In this study, therefore, we retrospectively examined our
cases of precipitous labor to identify the clinical signicance
and perinatal outcome following precipitous labor.
Patients and Methods
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 dened
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,
while prolonged labor is dened 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
regular contractions in parous women [5]. Deliveries in this
study occurred between the years 2009 and 2013 in the Japa-
nese Red Cross Katsushika Maternity Hospital, one of main
Perinatal Centers in Tokyo, Japan. In our hospital, oxytocin
has not been used in the routine for prevention of postpartum
Manuscript accepted for publication December 12, 2014
Department of Obstetrics and Gynecology, Japanese Red Cross Katsushika
Maternity Hospital, Tokyo, Japan. Email: czg83542@mopera.ne.jp
doi: http://dx.doi.org/10.14740/jocmr2058w
Articles © The authors | Journal compilation © J Clin Med Res and Elmer Press Inc™ | www.jocmr.org
151
Suzuki J Clin Med Res. 2015;7(3):150-153
hemorrhage in cases of precipitous labor. Data were collected
from the patients’ charts that consist of information collected
directly after delivery by the midwives who examine the in-
formation routinely before entering it into the database. The
following clinical characteristics and outcomes were analyzed:
parity; maternal age; gestational age; birth weight; maternal
complications such as hypertensive diseases, glucose intoler-
ance; placental abruption; oxytocin use; delivery modes; neo-
natal Apgar score at 1 and 5 min; umbilical artery pH; post-
partum hemorrhage requiring hemotransfusion; perineal tears
(severe perineal laceration: perineal laceration either third- or
fourth-degree laceration); and cervical tears.
In this study, we examined these clinical characteristics
and outcomes by comparing patients with precipitous labor
and those with labor of normal duration in 0 and two-parous
women.
Table 1. Incidences of Precipitous and Prolonged Singleton Labors
Parity Total
Vaginal labor
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)
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: condence 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
Statistical signicance was ascertained using the X
2
test or
Fisher’s exact test for differences in qualitative variables and
the Student’s t-test for differences in continuous variables. A
multivariate logistic regression model, with backward elimi-
nation, was constructed in order to nd independent factors
associated with precipitous labor. Odds ratios (ORs) and their
95% condence intervals (CIs) were computed. P < 0.05 was
considered statistically signicant.
Results
During the study period, there were 11,239 singleton deliveries
in our hospital as shown in Table 1. Of these, 1,606 (14.3%)
were precipitous deliveries. The incidence of precipitous labor
in the parous women (21.5%) was signicantly higher than
that in the nulliparous women (6.9%, OR: 3.66, 95% CI: 3.24
- 4.13, P < 0.01).
Table 2 shows clinical characteristics and outcomes of the
two groups of nulliparous women with precipitous and normal
labor. The women with precipitate deliveries were more likely
to be younger, at lower gestational age of delivery, without
oxytocin use, lower birth weight of infant, and hypertensive
disorders as compared to those without precipitate deliveries.
Using a multivariate analysis, precipitous labor was indepen-
dently associated with teenagers (adjusted OR: 1.71, 95% CI:
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 signicant
differences were noted between the two groups regarding ma-
ternal or neonatal complications as shown in Table 2.
Table 3 shows clinical characteristics and outcomes of the
two groups of two-parous women with precipitous and normal
labor. The women with precipitate deliveries were more likely
to have oxytocin use and hypertensive disorders as compared
to those without precipitate deliveries. Using a multivariate
analysis, precipitous labor was independently associated with
hypertensive disorders (adjusted OR: 2.64, 95% CI: 1.33 -
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: condence interval. Severe perineal laceration, perineal laceration either third- or
fourth-degree laceration.
Articles © The authors | Journal compilation © J Clin Med Res and Elmer Press Inc™ | www.jocmr.org
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Suzuki J Clin Med Res. 2015;7(3):150-153
5.24, P < 0.01). No signicant differences were noted between
the two groups regarding maternal or neonatal complications
as shown in Table 3.
Discussion
The incidence of precipitous labor in this study was about 14%
of all singleton deliveries, which seemed to be higher than
those reported in the United States and other countries: 0.1-
3% [1-3]. In Japan, the onset of labor is usually dened by the
patient’s report of the commencement of regular contractions
of 10-min intervals. The high incidence in this study may be
attributed to the different denitions as well as the diagnosis of
regular contractions by monitoring and not patient’s report in
other countries. In this study, in addition, the incidence of pre-
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-
vious studies [1-3].
In some previous studies [2, 3], one of main perinatal
complications associated with precipitous labor has been re-
ported to be placental abruption, because placental abruption
can cause tachysystole, and thus shorter deliveries. On the
contrary, we did nd the high incidence of placental abrup-
tion in the women with precipitous labor. The reason leading
to the different outcomes is not clear. However, our medical
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].
In this study, although the incidence of placental abruption was
not associated with precipitous labor, hypertensive disorders
seemed to attribute to the increased odds of precipitous labor.
Recently, the deciency of maternal immune response to the
fetus that may result in preeclampsia or in pregnancy loss has
been discussed as a rejection to the fetus [7, 8]. Therefore, in
hypertensive disorders such as preeclampsia, the pathophysi-
ology of rejection to the fetus may be able to cause effective
uterine contractions for early expulsion of the fetus. Other-
wise, the hypertensive disorders might be a preliminary stage
of the placental abruption.
In this study, teenagers and preterm delivery were asso-
ciated with precipitous labor in nulliparous women. The soft
residence of birth canal in young women may cause rapid de-
livery and prevent the extensive lacerations of the cervix, va-
gina, vulva or perineum. The smallness of infants in preterm
delivery may also prevent these lacerations. In addition, the
Japanese women seemed to wish to take cesarean delivery in
cases of preterm labor that can take a long time as expected,
and these trends might have contributed to the current results.
In an earlier study by Sheiner et al [3], precipitous labor
was associated with some maternal complications including
perineal lacerations, postpartum hemorrhage, retained placen-
ta, hemotransfusion and prolonged hospitalization. These ma-
ternal complications have been previously reported as possible
consequences of precipitous labor due to abnormally strong
uterine contractions combined with non-dilated cervix and
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
and preterm delivery in the precipitous labor of this study may
contribute to the unchanged incidence of maternal complica-
tions due to maternal soft birth canal and/or small fetus passing
through. Otherwise, the current outcomes may be attributed to
the different denitions of the commencement of regular con-
tractions between some studies.
In this study, at last, precipitous labor was not associated
with maternal or neonatal outcomes. The current result sup-
ports the previous observations [1-3].
Conclusion
Based on the current results, although precipitous labor was
associated with hypertensive disorders in singleton vertex de-
liveries, it was not associated with maternal or neonatal out-
comes.
Conicts of Interest
Authors have no disclosures or conicts of interest.
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