No abstract

Objective To examine the association between active phase arrest and perinatal outcomes. Methods This was a retrospective cohort study of women with term, singleton, cephalic gestations diagnosed with active phase arrest of labor, defined as no cervical change for two hours despite adequate uterine contractions. Women with active phase arrest who underwent a cesarean delivery were compared to those who delivered vaginally and women who delivered vaginally with active phase arrest were compared to those without active phase arrest. The association between active phase arrest, mode of delivery, and perinatal outcomes was evaluated using univariable and multivariable logistic regression models. Results We identified 1,014 women with active phase arrest: 33% (335) went on to deliver vaginally and the rest were delivered by cesarean. Cesarean delivery was associated with an increased risk of chorioamnionitis (aOR 3.37, 95% CI [2.21–5.15]), endomyometritis (aOR 48.41, [6.61–354]), postpartum hemorrhage (aOR 5.18, [3.42–7.85]), and severe postpartum hemorrhage (aOR 14.97, [1.77–126]). There were no differences in adverse neonatal outcomes. Among women who delivered vaginally, women with active phase arrest had significantly increased odds of chorioamnionitis (aOR 2.70, [1.22–2.36]]), and shoulder dystocia (aOR 2.37, [1.33–4.25]). However, there were no differences in the serious sequelae associated with these outcomes, including neonatal sepsis and Erb’s palsy. Conclusion Efforts to achieve vaginal delivery in the setting of active phase arrest may reduce the maternal risks associated with cesarean delivery without additional risk to the neonate