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Two traditional methods for diagnosing obstructed labor rely on the WHO partograph (Lancet 1994; 343:1399; based on Friedman's work) or the Zhang guideline (Obstet Gynecol 2010; 116:1281; based on the 95th percentile for slow labor progress). To study the obstetric outcomes associated with each method, researchers randomized seven Norwegian obstetric units to use the WHO partograph and seven to use the Zhang guideline. In all, 7300 nulliparous women in spontaneous full-term labor with cephalic presentation were enrolled.
Major outcomes were similar regardless of method for defining labor progression:
Diagnosis of obstructed labor (WHO, 46%; Zhang, 47%)
Duration of active phase (WHO, 6.1 hours; Zhang, 6.6 hours)
Augmentation with oxytocin (WHO, …