Factors Associated with Nonadherence to American College of Obstetricians and Gynecologists Guidelines for Labor...

The American College of Obstetricians and Gynecologists (ACOG)/Society for Maternal-Fetal Medicine Safe Prevention of Primary Cesarean Delivery guidelines provide minimum time criteria at which cesarean delivery (CD) should be performed for a labor arrest disorder. We evaluated factors associated with nonadherence to these guidelines.

This is a retrospective case-control study of CDs with an indication of labor arrest disorders at a single center from June 2018 to September 2021. Charts were reviewed for adherence to minimum criteria for failed induction of labor (IOL), arrest of dilation, and arrest of descent. Cases and controls were patients who underwent CD prior to (i.e., nonadherent) or after (i.e., adherent) meeting minimum criteria, respectively. Maternal, fetal, and system-level factors were compared.

Of 308 primary CDs with an indication of a labor arrest disorder, 54% met minimum ACOG criteria and 46% did not. Nonadherence was less likely for provider groups with 24-hour in-house coverage (adjusted odds ratio [aOR]: 0.39, 95% confidence interval [CI]: 0.19-0.76) and in the setting of maternal obesity (aOR: 0.49, 95% CI: 0.27-0.89). Nonadherence was more likely when Category II tracing was present (aOR: 1.89, 95% CI: 1.04-3.46). Nonadherence differed by type of labor arrest. Nonadherence was less likely in cases of failed IOL (aOR: 0.41, 95% CI: 0.25-0.66) and was more likely in cases of arrest of descent (aOR: 4.08, 95% CI: 2.35-7.07).

Multiple factors influence adherence to the ACOG guidelines for labor arrest disorders. Addressing modifiable factors may improve adherence and decrease CD rates.

· Nonadherence to the ACOG/Society for Maternal-Fetal Medicine guidelines was more common when labor was managed remotely.. · Nonadherence was more common in the presence of Category II fetal tracing.. · Nonadherence was more common in cases of arrest of descent.. · Nonadherence was less common in cases of failed induction of labor and maternal obesity.. · Addressing modifiable factors may improve adherence and decrease CD rates..