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Jeremy Neal, PhD, CNM, RN

Award Name Pilot Grant

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Role of Cervical Dilation in the Diagnosis of True Labor

The Ohio State University Center for Clinical and Translational Science has awarded Jeremy Neal, PhD, CNM, RN, a supplemental pilot award for his research about the role of maternal inflammatory markers in the diagnosis of active labor.

“I became very interested in the topic of when labor care providers admit women for labor,” said Neal, who worked in labor and delivery for 10 years.

Providers commonly aim to admit women in active labor when the rate of cervical dilation is expected to accelerate. It is estimated that about half of first-time, low-risk mothers are admitted too early.

Neal said using certain dilatations prospectively is problematic because they are poor predictors of active labor. Only adequate cervical change over time can indicate that a woman is in active labor, and this can only be known after-the-fact.

Previous studies have established that admitting women too early can lead to poorer outcomes for the mother and her baby.

“Early admission puts those moms at particular risk for more intervention during labor and for poorer birth outcomes, including a more than two-fold increase in cesarean rates, when compared to mothers admitted in active labor,” Neal said.

There is no sure way to prospectively predict the onset of active labor. Neal’s research is focused on finding markers that can predict active labor in first-time, low-risk mothers.

Since labor is thought to be a largely inflammatory event, Neal plans to look at changes in specific inflammatory markers.

After data is collected, he will look at women’s dilation rates in the hours following their admission in order to categorize them into an active labor or latent labor group. Latent labor is the point between spontaneous onset of regular contractions and the rate of cervical dilation accelerates.

Once categorized, Neal will look at differences in inflammatory markers to see if predicting the labor state was possible. If significant differences exist, he hopes to create protocols that can prospectively predict labor states in the clinical setting.

“The ultimate goal is to develop a tool that has the potential to predict active labor onset,” Neal said.

The study will take place at the OSU Medical Center. About 40 percent of women admitted to labor and delivery are first-time, low-risk mothers and will be eligible for participation.

Neal aims to recruit 200 women by the end of the study and will run preliminary testing on numbers smaller than that. He thinks he will be able to collect the data within a year of beginning the study.

“If inflammatory marker differences are measurable between active and latent admission groups, this program of research has a real potential to equip labor care providers with a tool to assist in their admission decision making,” Neal said.

“This could lead to improved labor outcomes for both mother and baby.”

By Emily Tramte, Wednesday, June 30, 2010

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