The Prince of Songkla University Pain Curve for Predicting Labor Progress

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Sasitorn Phumdoung
Sukit Mahattana
Kalaya Maneechot
Sununta Youngwanichsetha
Benjamach Chanudom


                 During labor not only labor pain but also vaginal examinations cause adverse effects on a woman and her fetus. Thus, it is essential to develop a method to monitor labor progress besides vaginal examinations. This applied research aimed to develop the Prince of Songkla University Pain Curve instrument and test its sensitivity in predicting labor progress during the first stage of labor. Primiparous women were recruited by convenient sampling in a labor room at a central hospital in southern Thailand. In phase I (n = 350), pain (using the 100 mm Visual Analogue Scale) and duration of time from each cervical dilation were recorded and then the Pain Curve was developed. In phase II (n = 350), the instrument was examined for its sensitivity in prediction of labor progress.
                Results indicated that it had a slightly moderate sensitivity in predicting progress of labor from latent to maximum slope phases, but had a high sensitivity in the deceleration phase. The implication is that to monitor labor progress, it might be beneficial to use this instrument additional to standard curve instruments. Using the Prince of Songkla Pain Curve could also lower a number of vaginal examinations in assessment cervical dilations for predicting labor progress. Further testing and refinement of this instrument is required in the future with different samples including Thai women in larger sample size. 

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Phumdoung S, Mahattana S, Maneechot K, Youngwanichsetha S, Chanudom B. The Prince of Songkla University Pain Curve for Predicting Labor Progress. PRIJNR [Internet]. 2017 May 5 [cited 2022 Aug. 8];21(2):148-57. Available from:
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1. Beigi NMA, Broumandfar K, Bahadoran P, Abedi HA. Women’s experience of pain during Childbirth. Iran J Nurs Midwifery Res. 2010; 15(2): 77-82.

2. Pillitteri, A. Maternal & child health nursing: Care of the childbearing & childrearing family (7 th ed.). Philedelphia: Wolters Kluwer; 2014.

3. Seval MM, Yuce T, Kalafat E, Duman B, Aker SS, Kumbasar H, et al. Comparison of effects of digital vaginal examination with transperineal ultrasound during labor on pain and anxiety levels: a randomized controlled trial. Ultrasound Obstet Gynecol. 2016; 48(6): 695-700.

4. Dixon L, Foureur M. The vaginal examination during labour: Is it of benefit or harm?. NZCOM Journal. 2010; 42: 21-26.

5. Oscarsson M, Benzein E. Women’s experiences of pelvic examination: an interview study. J Psychosom Obstet Gynaecol. 2002; 23(1): 17-25.

6. Wijma B, Gullberg M, Kjessler B. Attitudes towards pelvic examination in a random sample of Swedish women. Acta Obstet Gynecol Scand. 1998; 77(4): 422-28.

7. Lewin D, Fearon B, Hemmings V, Johnson G. Women’s experiences of vaginal examinations in labour. Midwifery. 2005; 21(3), 267-77.

8. Phumdoung S, Youngvanichsate S. Thai women’s experiences of receiving vaginal examinations during labor. Songkla Med J. 2009; 27(6): 465-70.

9. Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Rouse DJ, Spong CY. Williams obstetric (23 rd ed.). New York: Mc Graw Hill Medical; 2010.

10. Freeman LM, Adair V, Timperley H, West SH. The influence of the birthplace and models of care on midwifery practice for the management of women in labour. Women Birth. 2006; 19(4): 97-105.

11. Zhang J, Troendle JF, Yancey MK. Reassessing the labor curve in nulliparous women. Am J Obstet Gynecol. 2002; 187(4): 824-28.

12. Cesario SK. Reevaluation of Friedman’s labor curve: A pilot study. J Obstet Gynecol Neonatal Nurs. 2004; 33(6): 713-22.

13. Groeschel N, Glover P. The Partograph: Used daily but rarely questioned. Aust J Midwifery. 2001; 14(3): 22-27.

14. Yamane T. Statistics: An introductory analysis (2nd ed.). New York: Harper & Row; 1967.

15. Toh-adam R, Srisupundit K, Tongsong T. Short stature as an independent risk factor for cephalopelvic disproportion in a country of relatively small-sized mothers. Arch Gynecol Obstetet. 2012; 285: 1513-16.

16. Phumdoung S, Manasurakarn B, Rattanasombat K, Mahattanan S, Maneechot K, Chanudom B et al. Effect of the Prince of Songkla University Birthing Bed on duration, pain, and comfort level during second-stage labor in primiparous Thais. Pacific Rim Int J Nurs Res. 2013; 17(1): 56-67.

17. Good M, Stiller C, Zauszniewski JA, Anderson GC, Stanton-Hicks M, Grass JA. Sensation and distress of pain scales: reliability, validity, and sensitivity. J Nurs Meas. 2001; 9(3): 219-38.

18. Phumdoung S, Manasurkarn B, Rattanasombat K, Mahattana S, Maneechot K, Chanudom B, et al. Effect of the Prince of Songkla University Birthing Bed on duration, pain, and comfort level during second-stage labor in primiparous Thais. Pacific Rim Int J Nurs Res. 2013; 17(1): 56-67.

19. Cunningham FG, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL, et al. Williams obstetrics (24 th ed.). New York: Mc Graw Hill Medical Education; 2014.

20. Neal JL, Lowe NK, Patrick TE, Cabbage LA, Corwin, EJ. What is the slowest-yet-normal cervical dilation rate among nulliparous women with spontaneous labor onset?. J Obstet, Gynecol, and Neonatal Nurs. 2010, 39(4), 361-69.

21. Akobeng AK. Understanding diagnostic tests 1: sensitivity, specificity and predictive values. Acta Paediatrica. 2006; 96(3): 338-41.

22. Lalkhen AG, McCluskey A. Clinical test: sensitivity and specificity. CEACCP. 2008; 8(6): 221-23.

23. Ingram DL, Occhiuti AR, Herman PF. Moderate sensitivity, high specificity, and low positive predictive value of the group B streptococcal (GBS) Latex Agglutination (LA) antigen detection test. Pediatr Res. 1984; 18: 278A. (doi:10.1203/00006450-198404001-01109).

24. Kinns J, Mai W, Seiler G, Zwingenberger A, Johnson V, Caceres A, et al. Radiographic sensitivity and negative predictive value for acute canine spinal trauma. Vet Radiol Ultrasound. 2006; 47(6): 563-70.

25. Adjusting motion detection sensitivity. Retrieved February 5, 2017 from htmlom/.../id_om01_0250.htm

26. Frahm R, Mundt A. [Labor pain from the viewpoint of modern knowledge of pain physiology.] Zentralbl Gynäkol. 1986; 108(4): 203-11.

27. Chamnikul T, Srisaeng P. The effects of relative support program on pain during the first stage of labor among primiparous women. J Nurs Sci Health. 2010; 33(1): 33-42.

28. Madi BC, Sandall J, Bennett R, MacLeod C. Effects of female relative support in labor: A randomized controlled trial. Birth.1999; 26(1): 4-8.

29. Hodnett ED, Gates S, Hofmeyr GJ, Sakala C. Continuous support for women during childbirth. Cochrane Database Syst Rev.2012; Oct 17. doi:10. 1002/ 14651858. CD003766.pub4.

30. Phumdoung S. Inconsistency and ceiling effect in repeated measures of labor pain using VAS. Songkla Med J. 2004; 22(3): 155-61.