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A Novel Classification of Labor Dystocia: Developing a Physiologic Understanding to Facilitate Precision in Diagnosis and Individualized Management

Award Number: F31NR018582
ORGANIZATION: NATIONAL INSTITUTE OF NURSING RESEARCH
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: FELLOWSHIP/SCHOLARSHIP/STUDENT LOANS

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Project Summary/Abstract The Healthy People 2020 goals prioritize reduction of the cesarean rate by 10% for low-risk women. Labor dystocia accounts for almost 50% of cesarean deliveries (CD) in the United States (MICH-07.1). The American College of Obstetricians and Gynecologists and the Society for Maternal and Fetal Medicine identified accurate diagnosis of labor dystocia and the judicious use of CD for this indication as an opportunity to reduce the overall CD rate.1 In the United States, nearly half of all labors are augmented using Pitocin; however this augmentation has not been found to reduce the risk for CD. Moreover, some women with labor dystocia do not respond to Pitocin. The applicant seeks to contribute to understanding the pathophysiology of labor dystocia to find novel approaches to reducing the unnecessary use of Pitocin augmentation and CD. Elevated amniotic fluid lactate (AFL) and increased median Power Density Spectrum (PDS) frequency, a measure of the electrical activity of the uterine muscle during labor, recently were found to be associated with labor dystocia and CD. AFL and median PDS frequency monitoring have been proposed separately as tools for identifying women at risk for arrest of labor and CD. The proposed research will characterize labor dystocia phenotypes by AFL concentrations and median PDS frequency to improve diagnostic precision labor dystocia. Improving diagnostic precision for dystocia will allow for individualized management that reduces unnecessary CD and optimizes fetal and maternal outcomes. The applicant has synthesized research findings to classify labor dystocia by rate of cervical dilation graphed on a partograph, then by adequacy of uterine contractions, and AFL. The proposed research will contribute to a better understanding of the pathophysiology of labor dystocia to generate future research hypotheses that contribute to the development of the proposed phenotypic classification of labor dystocia. In addition, the proposed research will evaluate the correlation between point- of-care capillary lactate collected by maternal finger stick and AFL. Evaluation of AFL is limited as it can only be collected non-invasively following ruptured membranes. If point-of-care capillary lactate is predictably correlated with AFL, it may be used as an alternative biomarker beginning in early labor to identify abnormal labor patterns, from which an appropriate management plan is determined. Instead of uniform use of Pitocin augmentation, innovative interventions that rest and restore uterine contraction may be indicated, including tocolytics, dextrose, or sodium bicarbonate.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2023 ( Subtotal = -$16,776 )
2023	2021	REGENTS OF THE UNIVERSITY OF COLORADO, THE	13001 E 17TH PLACE F428	AURORA	CO	80045	ADAMS	USA	Nursing Research	001	3	11/23/2022	NON-COMPETING CONTINUATION	-$2,709
2023	2020	REGENTS OF THE UNIVERSITY OF COLORADO, THE	13001 E 17TH PLACE F428	AURORA	CO	80045	ADAMS	USA	Nursing Research	000	2	11/23/2022	NON-COMPETING CONTINUATION	-$14,067
														Subtotal = -$16,776

Issue Date FY: 2022 ( Subtotal = -$2,297 )
2022	2021	REGENTS OF THE UNIVERSITY OF COLORADO, THE	13001 E 17TH PLACE F428	AURORA	CO	80045	ADAMS	USA	Nursing Research	000	3	4/25/2022	NON-COMPETING CONTINUATION	-$2,297
														Subtotal = -$2,297

Issue Date FY: 2021 ( Subtotal = $5,006 )
2021	2021	REGENTS OF THE UNIVERSITY OF COLORADO, THE	13001 E 17TH PLACE F428	AURORA	CO	80045	ADAMS	USA	Nursing Research	000	3	4/16/2021	NON-COMPETING CONTINUATION	$5,006
														Subtotal = $5,006

Issue Date FY: 2020 ( Subtotal = $36,237 )
2020	2020	REGENTS OF THE UNIVERSITY OF COLORADO, THE	13001 E 17TH PLACE F428	AURORA	CO	80045	ADAMS	USA	Nursing Research	000	2	4/24/2020	NON-COMPETING CONTINUATION	$36,237
														Subtotal = $36,237

Issue Date FY: 2019 ( Subtotal = $35,763 )
2019	2019	REGENTS OF THE UNIVERSITY OF COLORADO, THE	13001 E 17TH PLACE F428	AURORA	CO	80045	ADAMS	USA	Nursing Research	001	1	3/29/2019	NEW	$0
2019	2019	REGENTS OF THE UNIVERSITY OF COLORADO, THE	13001 E 17TH PLACE F428	AURORA	CO	80045	ADAMS	USA	Nursing Research	000	1	3/29/2019	NEW	$35,763
														Subtotal = $35,763

Grand Total All Awards = $57,933

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A Novel Classification of Labor Dystocia: Developing a Physiologic Understanding to Facilitate Precision in Diagnosis and Individualized Management

Award Number: F31NR018582

ORGANIZATION: NATIONAL INSTITUTE OF NURSING RESEARCH

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: FELLOWSHIP/SCHOLARSHIP/STUDENT LOANS

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