Incidence and predictors of dystocia during the active first stage of labor among mothers at Debre Markos Comprehensive Specialized Hospital, Amhara, Northwest Ethiopia

Abstract

BACKGROUND: Dystocia of the active first stage of labor (AFSOL) significantly contributes to maternal and neonatal morbidity and mortality and is a major driver of rising cesarean delivery rates worldwide. Many determinants of AFSOL are potentially modifiable and context-specific, yet evidence from Ethiopia is limited. OBJECTIVE: To assess the incidence and predictors of dystocia during the active first stage of labor among laboring women at Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia, 2022. METHODS: A prospective follow-up study was conducted from October 20, 2022, to January 4, 2023, at Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia. A total of 656 laboring women were enrolled using systematic random sampling. Of these, 1.7% were lost to follow-up because cesarean delivery was performed before the completion of the active first stage of labor for reasons other than protracted or arrested cervical dilation. The remaining 94.5% of participants who completed follow-up were included in the analysis. Data were collected through direct observation, interviews using a pretested structured questionnaire, and medical record review. Data entry was done using Epi-data version 4.2, and analysis was performed with SPSS version 26. Descriptive statistics summarized participants' characteristics, and binary logistic regression was used to identify predictors of dystocia. Results were considered statistically significant at a p-value ≤ 0.05, and associations were reported as adjusted odds ratios (AOR) with 95% confidence intervals (CI). RESULTS: The incidence of AFSOL dystocia was 35.3% (95% CI: 31.9-39.2). Positive predictors included induction of labor (AOR: 2.3; 95% CI: 1.09-4.91), admission with cervical dilation < 4 cm (AOR: 2.7; 95% CI: 1.62-4.63), poor provider support (AOR: 7.3; 95% CI: 4.06-13.39), and caffeine intake ≥ 200 mg/day ( ~ ≥ 3 cups; AOR: 3.4; 95% CI: 1.70-6.84). Protective factors included linseed consumption at labor onset (AOR: 0.25; 95% CI: 0.12-0.51), antenatal care follow-up (AOR: 0.24; 95% CI: 0.09-0.63), and ambulation during labor (AOR: 0.23; 95% CI: 0.09-0.54). CONCLUSION: The incidence of dystocia during the active first stage of labor is high. ANC follow-up, linseed consumption, and ambulation are protective, whereas caffeine intake, labor induction, early admission, and poor provider support increase risk. Implementing WHO labor care guidelines and promoting evidence-based provider practices may reduce dystocia and unnecessary interventions.