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Related Experiment Videos

New labor management guidelines and changes in cesarean delivery patterns.

Joshua I Rosenbloom1, Molly J Stout1, Methodius G Tuuli1

  • 1Department of Obstetrics and Gynecology, Washington University in St Louis School of Medicine, St Louis, MO.

American Journal of Obstetrics and Gynecology
|October 18, 2017
PubMed
Summary

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The Consortium on Safe Labor guidelines did not reduce cesarean delivery rates or improve maternal and neonatal outcomes. Labor management changes did not lower the cesarean delivery rate, and adverse outcomes increased.

Area of Science:

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

Background:

  • The Consortium on Safe Labor published labor curves in 2010, proposing that avoiding arrest of dilation diagnoses before 6 cm could lower cesarean delivery rates.
  • Information on the adoption of these guidelines and their impact on cesarean delivery rates is limited.

Purpose of the Study:

  • To evaluate the impact of updated labor management guidelines on arrest of dilation and arrest of descent diagnoses.
  • To determine changes in cesarean delivery rates and associated maternal and neonatal morbidity.
  • To assess trends in cervical dilation at diagnosis and duration of the second stage of labor.

Main Methods:

  • Secondary analysis of a prospective cohort study (2010-2014) including 7845 term singleton vertex deliveries without prior cesarean.
Keywords:
arrest of descentarrest of dilationcesarean deliveryguidelineslabor managementmaternal morbidityneonatal morbidity

Related Experiment Videos

  • Calculated rates of cesarean delivery, arrest of dilation, and maternal/neonatal morbidity.
  • Compared cervical dilation at diagnosis, time at maximal dilation, and second-stage duration over the study period.

    • Main Results:

    • Cesarean delivery rates showed no significant trend (15.8% in 2010 vs. 17.7% in 2014).
    • Time spent at maximal cervical dilation increased significantly for arrest of dilation (3.8 to 5.2 hours) and arrest of descent (multiparous: 1.1 to 3.4 hours; nulliparous: 2.7 to 3.8 hours).
    • Adverse maternal and neonatal outcomes significantly increased (OR 1.66 and 1.80, respectively).

    Conclusions:

    • Updated labor management guidelines did not reduce the primary cesarean delivery rate in the observed period.
    • Significant increases in maternal and neonatal morbidity were observed, despite changes in labor management.
    • Further investigation, potentially through a randomized controlled trial, is warranted to clarify optimal labor management strategies.