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INTRODUCTION: To examine the use of cesarean delivery over time for labor arrest and failed induction and identify predictors of meeting criteria for these indications. METHODS: We analyzed rates of primary cesareans due to arrest of dilation, arrest of descent and failed induction among live births at Yale New Haven Hospital from 2010 through 2013. Criteria for labor arrest and failed induction were based on 2012 guidelines, and the proportions of deliveries meeting these criteria were calculated annually. Multiple logistic regression was used to assess cesarean delivery over time and identify predictors of meeting criteria. IRB approval was obtained. RESULTS: The total primary cesarean delivery rate decreased from 23.5% to 21.1% (<.03). The rate of primary cesarean delivery for arrest of dilation decreased from 5.1% to 3.4% (P<.0005), while the rate of meeting criteria for this indication increased from 18.8% to 34.9% (P<.003). Primary cesarean delivery for arrest of descent and failed induction remained stable; the percent of cases meeting criteria for arrest of descent increased from 57.8% to 71.0% (P<.007). Increased cervical dilation on admission increased the likelihood of meeting criteria for arrest of dilation and descent, and epidural use decreased the likelihood of meeting criteria for arrest of descent. As of 2013, 65.1% of primary cesareans for arrest of dilation, 29.0% for arrest of descent, and 50.0% for failed induction did not meet criteria. CONCLUSION: A decrease in the primary cesarean rate was associated with meeting new criteria for labor arrest. Increased adherence to these criteria could further reduce the cesarean rate.

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INTRODUCTION: National and Stamford Hospital cesarean delivery (CD) rates, at 32% and 40.4% respectively, remain high. A large contributor to the primary CD rate is labor arrest, including failed induction of labor (IOL). Use of new guidelines for diagnosing these conditions have been shown to decrease the CD rate. This study aims to assess adherence to new definitions and the impact of a pre-cesarean checklist at our institution. METHODS: A retrospective chart review for primary CD in nulliparous, singleton, term, vertex (NSTV) pregnancies performed for labor arrest, including failed IOL, from January 2018 to August 2019. In January 2019 a paper pre-cesarean checklist, adapted from a previously published checklist was introduced to labor and delivery to allow physicians to review labor arrest criteria. Calculated primary CD rates for labor arrest pre and post implementation were compared using chi square analysis. RESULTS: The primary cesarean delivery (pCD) rate in NSTV pregnancies for labor arrest was 14.1% in 2018 and 12.5% in 2019 (P=.5). Of the 55 pCD for labor arrest in 2019, 17 (30.9%) filled out the pre-cesarean checklist. Only 18 (32.79%) met criteria for labor arrest/failed IOL. CONCLUSION: At our institution, CD in NSTV pregnancies for labor arrest or failed IOL do not meet contemporary definitions. Introduction of a paper pre-cesarean checklist to evaluate labor arrest has not affected the CD rate. However, use of the checklist was limited, thus there remains significant room for a decrease in the cesarean rate if adherence can be improved.