Purpose: Determine if bed rest or walking during a 1-hour labor check evaluation affects progression to delivery.
Study Design: Randomized controlled trial.
Methods: Convenience sample of nulliparous full-term, low-risk women with an initial negative exam for active labor (cervical dilatation < 4 cm; intact membranes) were randomly assigned to bed rest or walking for 1 hour prior to reassessment. Cervical dilatation and comfort level were evaluated before and after 1 hour of bed rest or walking. For patients who delivered within 24 hours, time to delivery was documented. Data were analyzed with Student's t-test and c2-test. Positive and negative predictive values were calculated for the 1-hour labor check evaluation as a screen for delivery within 24 hours (negative screen = no change in cervical dilatation after 1 hour; positive screen = ≥1 cm change in cervical dilatation after 1 hour).
Results: Sixty-three participants were studied before and after a 1-hour period of bed rest (n = 32) or walking (n = 31). No differences were found between the groups in changes of cervical dilatation, time to delivery, number of women delivering within 24 hours, or maternal comfort after the 1-hour labor check evaluation. Predictive values of the 1-hour labor check evaluation to determine delivery within 24 hours were 88.2% (positive predictive value) and 54.3% (negative predictive value).
Clinical Implications: Cervical dilatation and time to delivery were similar for nulliparous, full-term, low-risk women regardless of activity level during a 1-hour, in-hospital labor check evaluation. The woman's preference can be used to determine activity level during a labor check evaluation. Positive 1-hour labor check evaluations were highly predictive of delivery within 24 hours. A negative 1-hour labor check evaluation, however, was not a good predictor of delivery within 24 hours.
Changes in cervical dilatation and time to delivery were the same whether bed rest or walking was used during a one-hour, in-hospital labor check evaluation.
Chris Selby, RNC, Sherry Valencia, BSN, RN, Lindsay Garcia, RN, Denise Keep, BSN, RN, Jonnie Overcash, BSN, MSN, RNC, and Jasmin Jackson, BSN, RN all are Staff Nurses at Labor and Delivery Unit, Saint Luke's Hospital of Kansas City, Kansas City, MO.
Chris Selby, the corresponding author, can be reached via e-mail at firstname.lastname@example.org.
The authors disclose that there are no financial relationships related to this article.
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