Dystocia in labour: diagnosis, management and culture of Italian midwives

Abstract

Objective. Dystocia in labour is the most common indication for primary caesarean sections. We have investigated how Italian midwives are informed and aware of the diagnosis of dystocia in labour, which strategies they implement and how their culture can affect clinical decisions. Methods. Purpose-built questionnaire using convenience sampling on a voluntary basis. The research was carried out on a population of Italian midwives. The questionnaire was divided into three macro-areas: socio-demographic information; a clinical case with decision questions; operators' knowledge and clinical choices. Results. 300 questionnaires were collected, and 289 were analysed. 60% of midwives would have not diagnosed active labour before 6 cm of dilation and would have adopted conservative management. 81% would adopt methods such as change of maternal posture, movement, and emotional support to solve dystocia rather than oxytocin and artificial rupture of membranes. 76% is aware that there is no single definition of dystocia, 80% do not know the definition of latent phase. The discussion on dystocia is rarely addressed in a context such as an audit. Conclusions. Culture considered as experience, knowledge, and work context, could affect clinical practice. Most midwives showed interest in the subject by tackling it with a view that was mainly physiological. The need for training and structured discussion meetings is, in any case, important.

Inconsistent definitions of prolonged labor in international literature: a scoping review

“…We identified 43 studies that focused on defining a prolonged first and/or second stage of labor as primary outcome. 14 , 17 , 31 , 35 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 All of these studies, except four, originated from North America or Europe. 44 , 72 , 73 , 77 The majority were observational studies (35, 81.4%).…”

“…The proposed centile values may assist in the definition of dystocia. Slowest 5th centile=0.5 cm/h, 10th centile 0.7 cm/h Lavender 2006 GB 61 RCT 2975 nulliparous Prolonged labor Crossing the action line of the WHO partograph, 2 vs 4 h Melman 2016 NL 63 Other (Delphi) 2060 women 18 O&G Nonprogression 2–4 h no progress after all measures taken (ROM, catheterization, pain relief, adequate contractions) Neal 2016 US 64 Other 34 nulliparous Labor dystocia Based on the dystocia line of the Neal & Lowe partograph (stepwise with different cut-offs per cm dilatation) Ragusa 2021 IT 67 Survey 289 midwives Dystocia in labor 76.8% of midwives investigated agree there is currently no unambiguous definition of labor dystocia, 12.1% would define dystocia as a lack of cervical dilation for more than 2 h and 11.1% think that dystocia occurs when labor proceeds at less than 1.2 cm/h in nulliparous women Romijn 2016 NL 68 Survey 147 healthcare workers Prolonged first stage of labor No clear definition but factors of influence: cervical dilatation, women's state of mind, intensity of contractions Rouse 1999 US 69 Prospective cohort 542 Active phase labor arrest 1 cm or less of cervical progress in 2 h. Extend minimum period of oxytocin from 2 to 4 h Rouse 2001 US 70 Prospective cohort 501 Active phase labor arrest 4 h (if >200 MVU) or 6 h (if <200 MVU) before CS for labor arrest. Majority of women (61%) who experience 2 h of labor arrest despite a sustained uterine contraction pattern of at least 200 Montevideo units will achieve vaginal delivery if oxytocin augmentation is continued.…”

The Art of Kielland rotational forceps delivery – do we need more training or should we abandon it? That is the question: a retrospective observational study

“…The need for training and structured discussion meetings, in any case, is important. Clinical audits compared to individual revision of clinical cases alone or to unstructured meetings between operators, are certainly more productive [17].…”

Italian Society of Gynaecology and Obstetrics (SIGO): Consensus paper on induction of labor with oral administration of Misoprostol

“…An induced labor generally tends to be longer compared to a spontaneous labor; this can impact the pregnant woman significantly from a psychological point of view (8,9). The factors that impact the most on the outcome of an IOL are the patient's compliance to the procedure and continuity of care (10).…”