Adherence to New Definitions of Labor Arrest and Failed Induction Decreases Primary Cesareans [16F]

Abstract

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.

Cesarean Delivery Trends Among Patients at Low Risk for Cesarean Delivery in the US, 2000-2019

“… 1 , 3 It is possible that the trends demonstrated in this study represent uptake of clinical management recommendations based on contemporary labor data by Zhang et al, 28 which demonstrate slower normal labor progress than the historical standards provided by Friedman. 29 Smaller clinical studies 4 , 6 , 7 , 8 have demonstrated varied findings when longer labor definitions are adopted into clinical management, with some centers demonstrating decreased cesarean deliveries performed for labor arrest and dystocia. Given that trends in decreasing low-risk cesarean deliveries began in 2010, it is possible that physician recognition of increasing population-level labor duration was already beginning to change clinical practice when society guidance was released.…”

“…3 The American College of Obstetricians and Gynecologists and Society for Maternal-Fetal Medicine (SMFM) subsequently made specific recommendations for diagnosing labor arrest. 1 Since this guidance, several studies [4][5][6][7][8] have examined trends in cesarean delivery rates and maternal and neonatal outcomes. An analysis 9…”

“… 3 The American College of Obstetricians and Gynecologists and Society for Maternal-Fetal Medicine (SMFM) subsequently made specific recommendations for diagnosing labor arrest. 1 Since this guidance, several studies 4 , 5 , 6 , 7 , 8 have examined trends in cesarean delivery rates and maternal and neonatal outcomes. An analysis 9 of births in California found that nulliparous, full-term, singleton, vertex cesarean births decreased from 2014 to 2019, in the context of a statewide quality improvement effort.…”