What is known from the existing literature about the physiological and pathological plateaus of labor?

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INTRODUCTION: Labor progression is traditionally considered linear; however, recent evidence highlights natural variations, including pauses or plateaus in contraction intensity or cervical dilation. Recognizing these variations is crucial, as a lack of clear distinction between physiological and pathological plateaus often leads to unnecessary interventions with potential short- and long-term consequences. This scoping review aims to map and summarize the characteristics, differences and management strategies of physiological and pathological labor plateaus in low-risk women. EVIDENCE ACQUISITION: This scoping review was conducted following the Joanna Briggs Institute (JBI) methodology and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and its extension for scoping reviews (PRISMA-ScR). Eligibility criteria included studies on physiological term pregnancies detailing labor plateau characteristics or management strategies. We searched five databases (MEDLINE, CINAHL, Embase, Scopus, CENTRAL), relevant gray literature, and reference lists of included studies, without restrictions on time, geography, or setting. Two reviewers independently screened abstracts and full-text articles for inclusion. Data were synthesized narratively and summarized in tables. EVIDENCE SYNTHESIS: We included 35 studies. Definitions of labor plateaus varied widely. Factors contributing to labor plateaus were categorized into modifiable and non-modifiable factors. Management strategies ranged from non-invasive approaches such as emotional support and hydration to invasive interventions like amniotomy and oxytocin administration. CONCLUSIONS: Current literature does not clearly distinguish between physiological and pathological labor plateaus. Standardized definitions and management protocols are needed to improve clinical outcomes. Recognizing the potential for physiological progression during plateaus may help balance timely interventions with the benefits of supporting natural labor processes.

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