The first stage begins at labor onset, and ends when the cervix is fully dilated—10 cm. Regional anesthesia is an effective method of pain reduction. Routine vaginal disinfection with chlorhexidine does not prevent maternal or neonatal infections compared to no disinfection. Intrapartum antibiotic prophylaxis is recommended for all GBS-positive women, with penicillin being the first-line antibiotic. For women with term pre-labor rupture of membranes, whose latency is expected to be greater than 12 h until delivery, intrapartum antibiotic prophylaxis can be considered. Aromatherapy with essential oils (lavender, jasmine, rose, almond, or a mixture) through inhalation or back massage, or immersion in water can be considered to help reduce labor pain. A policy of less restrictive food intake is associated with a shorter duration of labor without an increase in adverse maternal or neonatal outcomes and thus is recommended. In the setting of oral restriction, IVF at a rate of 250 ml/hr. containing dextrose is associated with a shorter duration of labor. Women without regional anesthesia who sit, stand, squat, kneel, or walk have shorter durations of labor, and are more likely to have spontaneous vaginal birth with lower rates of operative vaginal delivery compared with those in a recumbent, supine, or lateral position. For women with regional anesthesia, there is no difference in duration of labor, rates of spontaneous vaginal birth, or operative vaginal delivery or cesarean section with upright positions or walking compared to those in the recumbent, supine, or lateral position. Continuous bladder catheterization in women with regional anesthesia is not associated with a shorter duration of labor, and in fact might be associated with higher rates of cesarean section. There is no recommended frequency of cervical exams, or sweeping of membranes in the first stage of labor. The routine use of a partogram or peanut balls cannot be recommended as routine interventions, as they are not associated with significant reductions in duration of labor. The routine use of amniotomy alone in normally progressing spontaneous labor cannot be recommended; however, oxytocin augmentation alone has been found to shorten the time to delivery for women making slow progress in spontaneous labor. Early intervention with oxytocin and amniotomy for the prevention and treatment of dysfunctional or slow labor is recommended, as this has been shown to decrease the time to delivery. The routine use of the IUPC is not associated with a reduction of adverse pregnancy outcomes. The routine use of an ultrasound is not recommended. Cesarean for arrest should not be performed unless labor has arrested for a minimum of 4 h with adequate uterine activity, or 6 h with inadequate uterine activity in a woman with ROM, adequate oxytocin, and ≥6 cm dilated cervix.

First Stage of Labor

章节
发表日期：

2026年

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Leen Alhafez,
Vincenzo Berghella

摘要

The first stage begins at labor onset, and ends when the cervix is fully dilated—10 cm. Regional anesthesia is an effective method of pain reduction. Routine vaginal disinfection with chlorhexidine does not prevent maternal or neonatal infections compared to no disinfection. Intrapartum antibiotic prophylaxis is recommended for all GBS-positive women, with penicillin being the first-line antibiotic. For women with term pre-labor rupture of membranes, whose latency is expected to be greater than 12 h until delivery, intrapartum antibiotic prophylaxis can be considered. Aromatherapy with essential oils (lavender, jasmine, rose, almond, or a mixture) through inhalation or back massage, or immersion in water can be considered to help reduce labor pain. A policy of less restrictive food intake is associated with a shorter duration of labor without an increase in adverse maternal or neonatal outcomes and thus is recommended. In the setting of oral restriction, IVF at a rate of 250 ml/hr. containing dextrose is associated with a shorter duration of labor. Women without regional anesthesia who sit, stand, squat, kneel, or walk have shorter durations of labor, and are more likely to have spontaneous vaginal birth with lower rates of operative vaginal delivery compared with those in a recumbent, supine, or lateral position. For women with regional anesthesia, there is no difference in duration of labor, rates of spontaneous vaginal birth, or operative vaginal delivery or cesarean section with upright positions or walking compared to those in the recumbent, supine, or lateral position. Continuous bladder catheterization in women with regional anesthesia is not associated with a shorter duration of labor, and in fact might be associated with higher rates of cesarean section. There is no recommended frequency of cervical exams, or sweeping of membranes in the first stage of labor. The routine use of a partogram or peanut balls cannot be recommended as routine interventions, as they are not associated with significant reductions in duration of labor. The routine use of amniotomy alone in normally progressing spontaneous labor cannot be recommended; however, oxytocin augmentation alone has been found to shorten the time to delivery for women making slow progress in spontaneous labor. Early intervention with oxytocin and amniotomy for the prevention and treatment of dysfunctional or slow labor is recommended, as this has been shown to decrease the time to delivery. The routine use of the IUPC is not associated with a reduction of adverse pregnancy outcomes. The routine use of an ultrasound is not recommended. Cesarean for arrest should not be performed unless labor has arrested for a minimum of 4 h with adequate uterine activity, or 6 h with inadequate uterine activity in a woman with ROM, adequate oxytocin, and ≥6 cm dilated cervix.