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Updated: Apr 14, 2026

Author Spotlight: Advancing Labor Management Through Electromyometrial Imaging for Understanding Uterine Contractions
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Misguided guidelines for managing labor.

Wayne R Cohen1, Emanuel A Friedman2

  • 1Department of Obstetrics and Gynecology, University of Arizona College of Medicine, Tucson, AZ.

American Journal of Obstetrics and Gynecology
|April 21, 2015
PubMed
Summary

New labor management guidelines from the American Congress of Obstetricians and Gynecologists (ACOG) and Society for Maternal-Fetal Medicine (SMFM) lack clinical evidence. These untested protocols may harm mothers and infants, despite potential reductions in cesarean deliveries.

Keywords:
labor assessmentlabor curveobstetric guidelinespartogram

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Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine
  • Clinical Obstetrics

Background:

  • New guidelines for labor assessment and management by ACOG and SMFM have been issued.
  • These guidelines are based on a novel concept of labor progression from Zhang et al.
  • Previous concerns regarding these guidelines were raised in a recent review.

Purpose of the Study:

  • To critique the scientific basis of the new ACOG/SMFM labor management guidelines.
  • To argue against the replacement of the established Friedman system for labor aberration management.
  • To emphasize the need for evidence of superior outcomes before adopting new labor protocols.

Main Methods:

  • Critical review and analysis of the Zhang et al. labor progression curve.
  • Comparison of the new guidelines with established clinical principles and the Friedman system.
  • Assessment of the potential risks and benefits of the new guidelines.

Main Results:

  • The Zhang et al. labor dilatation curve is inconsistent with direct clinical observation.
  • The new ACOG/SMFM guidelines are not supported by sufficient clinical evidence.
  • Replacing the Friedman system with untested protocols may lead to adverse outcomes for mothers and infants.

Conclusions:

  • The ACOG/SMFM labor management guidelines require further validation through prospective studies.
  • The potential harms of adopting these untested guidelines must be thoroughly investigated.
  • Clinical management recommendations should prioritize demonstrated superior outcomes for maternal and fetal well-being.