Download PDF
Am J Perinatol 2024; 41(05): 618-627
DOI: 10.1055/a-1745-1570
Original Article

Adherence to Definitions of Labor Arrest Influence on Primary Cesarean Delivery Rate

Jessica T. Greenberg 
1   Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
2   Department of Obstetrics and Gynecology, Stamford Hospital, Stamford, Connecticut
,
Sarah N. Cross
1   Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
3   Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota, Minneapolis, Minnesota
,
Cheryl A. Raab
4   Women's Service, Yale New Haven Hospital, New Haven, Connecticut
,
Christian M. Pettker
1   Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
,
Jessica L. Illuzzi
1   Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
› Author Affiliations Funding J.T.G. was supported by the Office of Student Research at Yale School of Medicine. They had no input in the study design, collection, analysis, or interpretation of data or in writing the report or deciding to submit for publication.
› Further Information
Also available at
    Permissions and Reprints

Abstract

Objective The cesarean delivery rate in the United States is 31.9%. One of the leading indications for primary cesarean delivery is labor arrest. A modern understanding of the labor curve supports more time prior to the diagnosis of labor arrest. We conducted this study to examine the impact of adherence to the modern criteria for labor arrest and failed induction on rates of primary cesarean delivery and to identify predictors of meeting these criteria.

Study Design We analyzed rates of primary cesarean deliveries overall and primary cesarean deliveries occurring due to arrest of dilation, arrest of descent, and failed induction among the 17,877 live births at a large academic center from 2010 through 2013. Multiple logistic regression modeling identified predictors of meeting the new criteria for these indications based on guidelines published by the 2012 National Institute of Child Health and Human Development.

Results The primary cesarean delivery rate decreased from 23.5 to 21.1% (p = 0.026) from 2010 to 2013. Primary cesarean delivery rate for labor arrest and failed induction decreased from 8.5 to 6.7% (p = 0.005). The percentage of primary cesarean deliveries meeting the 2012 criteria for labor arrest increased from 18.8 to 34.9% (p = 0.002), and the rate of primary cesarean deliveries due to arrest of dilation decreased from 5.1 to 3.4% (p < 0.0005). The percentage of cases meeting the 2012 criteria for arrest of descent increased from 57.8 to 71.0% (p < 0.007), while primary cesarean delivery rate due to arrest of descent remained relatively unchanged, 3.1 to 2.6% (p = 0.330).

Conclusion A decrease in the primary cesarean rate was attributable to a decrease in cesarean for arrest of dilation in the setting of a significant increase in meeting the 2012 criteria for arrest of dilation. At the end of the study period, 65.2% of cesareans still did not meet the criteria for arrest of dilation. Greater rates of adherence to these guidelines may yield further reductions in the cesarean rate.

Key Points

  • Primary cesarean delivery for labor arrest was decreased.

  • Meeting criteria for labor arrest increased.

  • A hospitalist provider increased odds of meeting criteria.

Keywords

arrest of descent - arrest of dilation - failed induction of labor - labor arrest - labor curve - primary cesarean delivery - indication for cesarean delivery

Note

Abstract was presented at 68th ACOG Annual Clinical and Scientific Meeting, Nashville, TN May 3 to 6, 2019.




Publication History

Received: 06 March 2021

Accepted: 17 January 2022

Accepted Manuscript online:
19 January 2022

Article published online:
02 March 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Martin JA, Hamilton BE, Osterman MJK, Driscoll AK. Births: final data for 2018. Natl Vital Stat Rep 2019; 68 (13) 1-47
    PubMedSearch in Google Scholar
  • 2 Caughey AB, Cahill AG, Guise JM, Rouse DJ. American College of Obstetricians and Gynecologists (College), Society for Maternal-Fetal Medicine. Safe prevention of the primary cesarean delivery. Am J Obstet Gynecol 2014; 210 (03) 179-193
    CrossrefPubMedSearch in Google Scholar
  • 3 Spong CY, Berghella V, Wenstrom KD, Mercer BM, Saade GR. Preventing the first cesarean delivery: summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, and American College of Obstetricians and Gynecologists Workshop. Obstet Gynecol 2012; 120 (05) 1181-1193
    CrossrefPubMedSearch in Google Scholar
  • 4 Barber EL, Lundsberg LS, Belanger K, Pettker CM, Funai EF, Illuzzi JL. Indications contributing to the increasing cesarean delivery rate. Obstet Gynecol 2011; 118 (01) 29-38
    CrossrefPubMedSearch in Google Scholar
  • 5 Cross SN, Greenberg JT, Pettker CM, Raab CA, Illuzzi JL. Indications contributing to the decreasing cesarean delivery rate at an academic tertiary center. Am J Obstet Gynecol MFM 2019; 1 (02) 165-172
    CrossrefPubMedSearch in Google Scholar
  • 6 Zhang J, Landy HJ, Ware Branch D. et al; Consortium on Safe Labor. Contemporary patterns of spontaneous labor with normal neonatal outcomes. Obstet Gynecol 2010; 116 (06) 1281-1287
    CrossrefPubMedSearch in Google Scholar
  • 7 MacDorman M, Declercq E, Menacker F. Recent trends and patterns in cesarean and vaginal birth after cesarean (VBAC) deliveries in the United States. Clin Perinatol 2011; 38 (02) 179-192
    CrossrefPubMedSearch in Google Scholar
  • 8 von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 2008; 61 (04) 344-349
    CrossrefPubMedSearch in Google Scholar
  • 9 Rosenbloom JI, Stout MJ, Tuuli MG. et al. New labor management guidelines and changes in cesarean delivery patterns. Am J Obstet Gynecol 2017; 217 (06) 689.e1-689.e8
    CrossrefPubMedSearch in Google Scholar
  • 10 American College of Obstetricians and Gynecologists' Committee on Patient Safety and Quality Improvement, American College of Obstetricians and Gynecologists' Committee on Obstetric Practice. Committee Opinion No. 657 Summary: The Obstetric and Gynecologic Hospitalist. Obstet Gynecol 2016; 127 (02) 419
    CrossrefPubMedSearch in Google Scholar
  • 11 Metz TD, Allshouse AA, Gilbert SAB, Doyle R, Tong A, Carey JC. Variation in primary cesarean delivery rates by individual physician within a single-hospital laborist model. Am J Obstet Gynecol 2016; 214 (04) 531.e1-531.e6
    CrossrefPubMedSearch in Google Scholar
  • 12 Zhang J, Troendle J, Mikolajczyk R, Sundaram R, Beaver J, Fraser W. The natural history of the normal first stage of labor. Obstet Gynecol 2010; 115 (04) 705-710
    CrossrefPubMedSearch in Google Scholar
  • 13 Smith H, Peterson N, Lagrew D, Main E. Toolkit to Support Vaginal Birth and Reduce Primary Cesareans: A Quality Improvement Toolkit. Stanford, CA: California Maternal Quality Care Collaborative; 2016
    Search in Google Scholar
  • 14 Bell AD, Joy S, Gullo S, Higgins R, Stevenson E. Implementing a systematic approach to reduce cesarean birth rates in nulliparous women. Obstet Gynecol 2017; 130 (05) 1082-1089
    CrossrefPubMedSearch in Google Scholar
  • 15 Wilson-Leedy JG, DiSilvestro AJ, Repke JT, Pauli JM. Reduction in the cesarean delivery rate after obstetric care consensus guideline implementation. Obstet Gynecol 2016; 128 (01) 145-152
    CrossrefPubMedSearch in Google Scholar
  • 16 Thuillier C, Roy S, Peyronnet V, Quibel T, Nlandu A, Rozenberg P. Impact of recommended changes in labor management for prevention of the primary cesarean delivery. Am J Obstet Gynecol 2018; 218 (03) 341.e1-341.e9
    CrossrefPubMedSearch in Google Scholar
  • 17 Socol ML, Garcia PM, Peaceman AM, Dooley SL. Reducing cesarean births at a primarily private university hospital. Am J Obstet Gynecol 1993; 168 (6 Pt 1): 1748-1754 , discussion 1754–1758
    CrossrefPubMedSearch in Google Scholar
  • 18 Oshiro BT, Henry E, Wilson J, Branch DW, Varner MW. Women and Newborn Clinical Integration Program. Decreasing elective deliveries before 39 weeks of gestation in an integrated health care system. Obstet Gynecol 2009; 113 (04) 804-811
    CrossrefPubMedSearch in Google Scholar
  • 19 Fisch JM, English D, Pedaline S, Brooks K, Simhan HN. Labor induction process improvement: a patient quality-of-care initiative. Obstet Gynecol 2009; 113 (04) 797-803
    CrossrefPubMedSearch in Google Scholar
  • 20 Donovan EF, Lannon C, Bailit J, Rose B, Iams JD, Byczkowski T. Ohio Perinatal Quality Collaborative Writing Committee. A statewide initiative to reduce inappropriate scheduled births at 36(0/7)-38(6/7) weeks' gestation. Am J Obstet Gynecol 2010; 202 (03) 243.e1-243.e8
    CrossrefPubMedSearch in Google Scholar