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MULTI-STATE MODELS FOR PROGRESSION OF THE FIRST STAGE OF SPONTANEOUS LABOUR
As most pregnancy-related deaths and morbidities are clustered around the time of child birth, the quality of care during this period is crucial for mothers and their babies. To monitor the women at this stage, the partograph has been the central tool used in recent decades and, because of its simplicity, is frequently used in low-and middle-income countries. However, its use is highly questioned due to lack of evidence to justify a contribution to labor. In this paper we propose the use of multi-state models to explore the progression of the first stage of spontaneous labour, considering augmentation of labour as an intermediate state between vaginal delivery and cesarean section. Also, we considered information about cervical dilatation, membranes status, previous parity, comorbidity or pre pregnancy complications and if the woman was referred from another health facility. Due to the repeated assessments of cervical dilatation over time in labour monitoring, this variable was considered as fixed and time-dependent approaches.
BOLD project, labor modeling, markov process, multi-state model, time dependent covariates
Análise de Sobrevivência
Alexandre Cristovão Maiorano, Gleici Castro Perdoná, Hayala Cristina Cavenague Souza, Franciso Louzada