Predictors of labor abnormalities in university hospital: unmatched case control study

BACKGROUND: Abnormal labor is one of the common emergency obstetric problems contributing for more than two-thirds of the unplanned cesarean section. In Ethiopia, although labor abnormality and its complications like obstetric fistula are highly prevalent, there is no published study that determines the predictors of labor abnormalities. METHODS: The study design was an unmatched case control which included 844 women (408 cases and 436 controls). Cases were identified when a woman was diagnosed to have one of the labor abnormalities at term (prolonged latent stage, active phase disorder, prolonged second stage, descent disorder and obstructed labor). Subgroup logistic regression analyses were done taking the different type of labor abnormalities as the dependent variable. RESULTS: Nearly half of the cases (48.6%) were found to have the active phase disorder. Obstructed labor alone accounted for about 16.8% of the cases. The mean gestational age of cases and controls was almost comparable. More than a quarter of cases and controls came to the hospital in the second stage of labor. More than two-thirds of the cases (67.4%) gave birth by cesarean section. The logistic regression analysis demonstrated an independent association of overall labor abnormality with pelvic inadequacy. The subgroup analysis, however, revealed that several obstetric factors were associated with one or more types of labor abnormalities. CONCLUSION: Active phase disorders were the commonest type of labor abnormalities. Cases were late in reporting to the hospital. Malposition, inadequate pelvis and inadequate uterine contraction were some of the predictors of specific types of labor abnormalities.