Latent phase of labor

INTRODUCTION

Normal labor refers to the presence of regular uterine contractions that cause progressive dilation and effacement of the cervix and fetal descent. It is viewed in terms of its phases: latent, active, and decelerative; and its stages: first, second, and third.

The latent phase of labor will be reviewed here. Other aspects of labor and labor abnormalities are discussed separately:

• (See "Mechanism of normal labor and delivery".)
• (See "Abnormal labor: Protraction and arrest disorders".)
• (See "Management of normal labor and delivery".)

DIAGNOSIS

Latent phase — The initial phase of labor is termed the latent phase. It begins at the point at which the woman perceives regular uterine contractions. These contractions gradually soften, efface, and begin to dilate the cervix. This simple definition belies a complex process not completely understood by modern science. Women have irregular contractile activity beginning in the midtrimester, with gradual alterations in the size, shape, and consistency of the cervix occurring over the remaining months of the pregnancy [1,2]. This makes accurate assessment of the onset of latent phase difficult since determining exactly when a patient has entered latent phase is primarily based upon the woman's history and the judgment of the attending provider.

The end of the latent phase occurs when the active phase begins. Precise determination of the time that latent phase ends is also problematic. The active phase is defined as the period when changes in cervical dilation accelerate to at least 1 to 2 cm per hour and the fetus descends into the birth canal. A study of the transition from latent to active phase in uncomplicated pregnancies observed that 60 percent of patients reached the latent-active phase transition by 4 cm dilation and 90 percent by 5 cm dilation [3].