Impact of recommended changes in labor management for prevention of the primary cesarean delivery

Thuillier, Claire; Roy, Sophie; Peyronnet, Violaine; Quibel, Thibaud; Nlandu, Aurélie; Rozenberg, Patrick

doi:10.1016/j.ajog.2017.12.228

Cited by 79 publications

(59 citation statements)

References 33 publications

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“…A randomized controlled study in 2016 showed that the prolonged second stage of labor could promote the rate of vaginal delivery and reduce the rate of cesarean section, but the impact of the prolonged second stage of labor on the adverse outcomes of mothers and infants was not statistically significant [ 18 ]. Thuillier C and Zipori Y reported the new consensus recommendations was associated with the reduction of the rate of primary cesarean delivery [ 6 , 19 ]. Ausbeck EB’s research showed prolonged second stage was associated with adverse maternal outcomes significantly, but not with adverse neonatal outcomes [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

The impact of stage of labor on adverse maternal and neonatal outcomes in multiparous women: a retrospective cohort study

Wang

et al. 2020

BMC Pregnancy Childbirth

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Background The correlation between stage of labor and adverse delivery outcomes has been widely studied. Most of studies focused on nulliparous women, it was not very clear what impact the stage of labor duration had on multiparous women. Methods A retrospective cohort study was conducted among all the multiparous women of cephalic, term, singleton births, who planned vaginal delivery. The total stage of labor covered the first stage and the second stage in this study, and they were divided into subgroups. Adverse maternal outcomes were defined as referral cesarean delivery, instrumental delivery, postpartum hemorrhage, perineal laceration (III and IV degree), hospitalization stay ≥90th, and adverse neonatal outcomes as NICU, shoulder dystocia, Apgar score ≤ 7(5 min), neonatal resuscitation, assisted ventilation required immediately after delivery. Results There were 7109 parturients included in this study. The duration of first stage was 6.2(3.6–10.0) hours, the second stage was 0.3(0.2–0.7) hour, the total stage was 6.9(4.1–10.7) hours in multiparous women. At the first stage, the rates of overall adverse outcome were 21, 23.4, 28.8, 35.5, 38.4% in subgroups < 6 h, 6–11.9 h, 12–17.9 h, 18–23.9 h, ≥24 h, which increased significantly (X2 = 57.64, P < 0.001), and ARR (95% CI) were 1.10 (0.92,1.31), 1.33 (1.04,1.70), 1.80 (1.21,2.68), 2.57 (1.60,4.15) compared with subgroup < 6 h (ARR = 1); At the second stage, the rates of overall adverse outcome were 20.0, 30.7, 38.5, 61.2, 69.6% in subgroups < 1 h, 1–1.9 h, 2–2.9 h, 3–3.9 h, ≥4 h (X2 = 349.70, P < 0.001), and ARR (95% CI) were 1.89 (1.50, 2.39), 2.22 (1.55, 3.18), 10.64 (6.09, 18.59), 11.75 (6.55, 21.08) compared with subgroup < 1 h (ARR = 1)). At the total stage, the rates of overall adverse outcome were 21.5, 30.8, 42.4% in subgroups < 12 h, 12–23.9 h, ≥24 h (X2 = 84.90, P < 0.001), and ARR (95% CI) were 1.41 (1.16,1.72), 3.17 (2.10,4.80) compared with subgroup < 12 h (ARR = 1). Conclusions The prolonged stage of labor may lead to increased adverse outcomes in multiparous women, it was an independent risk factor of adverse maternal and neonatal outcomes.

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Section: Discussionmentioning

confidence: 99%

The impact of stage of labor on adverse maternal and neonatal outcomes in multiparous women: a retrospective cohort study

Wang

et al. 2020

BMC Pregnancy Childbirth

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“…Thuillier et al noted a decrease in CD rate from 9.4 to 6.9%, with a significant decrease in first-stage labor arrest of 50% in nulliparous women, although no other differences in outcomes were noted. 8 Wilson-Leedy et al 9 found a 40% reduction in both the overall cesarean section rate and the rate of arrest of dilation at less than 6 cm from 6 to 1%. 8 The overall CD rate at our institution was 13%, which is considerably lower than the national rate of 25 to 30%.…”

Section: Discussionmentioning

confidence: 97%

Maternal and Neonatal Morbidity after Cesarean Delivery for Active Phase Arrest following Adoption of the Obstetric Care Consensus Guidelines

et al. 2021

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Objective In an effort to reduce the primary cesarean delivery (CD) rate, the American College of Obstetricians and Gynecologists (ACOG) recommended new labor guidelines in 2014 that allow longer duration of labor times. There are little data on the impact of these guidelines on CD rates and pregnancy outcomes in a predominantly Hispanic population. This study aimed to compare the primary CD rates and maternal and neonatal outcomes in patients undergoing primary CD for arrest of labor before and after implementation of the 2014 guidelines. Study Design This was a retrospective cohort study of term patients who underwent a CD for an arrest disorder between January 2011 and April 2017 at a county teaching hospital. Our primary outcome was the composite maternal and neonatal morbidities (CMM and CNM, respectively). Differences in the demographic and clinical characteristics, CMM, and CNM stratified by time period (pre- vs. postimplementation) were examined. Results There were 4,976 deliveries in the study period: 525 (11%) underwent primary CD for arrest disorder; 298 (6%) prior to 2014, and 227 (5%) after 2014 (p = 0.62). There was no significant difference in the rate of CD between the two periods (13.4 vs. 13.3%, p = 0.81). In patients undergoing CD for arrest of dilation (n = 389), the CMM and CNM did not significantly change between both groups (63.3 vs. 56%, p = 0.15). In patients who had a CD for arrest of descent (n = 136), the rate of CMM significantly increased from 50 to 75% (p = 0.02) with no significant change in the CNM (13.2 vs. 20%, p = 0.3). Conclusion Despite significant changes in labor management after the publication of the 2014 guidelines, our primary CD rate was not reduced, and we noticed an increase in CMM in patients who had CD for arrest of descent. A randomized controlled trial is needed to further evaluate the effect of these guidelines nationally. Key Points

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“…While the cesarean delivery is inevitable in absolute indications, the preference of the physician and especially the expectant mother has an effect on determining the delivery method in relative indications. In recent years, the increase in the demand for cesarean delivery other than medical indications is a non-ignorable fact [4,5]. When determining the method of delivery, women generally have difficulty in making decisions.…”

Section: Introductionmentioning

confidence: 99%

Comparison of anesthesia professionals' preferences of delivery method with other health professionals

Ertürk

Akdoğan

ARSLAN³

2021

J CLIN MED KAZ

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Work areas and clinical practices have an effect on cesarean rates, which are also high in health professionals. Anesthesia professionals and the health professionals who are far from surgical practices may have different views on delivery methods. In this study, it was aimed to investigate which delivery method between vaginal delivery and cesarean delivery was selected by the anesthesia professionals and the health professionals outside the operating room, and why they selected it.Material and methods: 137 anesthesia professionals and 151 health professionals who had never worked in the operating room were included in this study. The participants' ages, professions and methods of delivery and reasons were questioned by the survey method.Results: While 58.3% of all the participants preferred the cesarean delivery method at their first birth, 41.7% preferred vaginal delivery. The preference rates of anesthesia professionals for cesarean delivery (69.9%) were found higher than those of the professionals working outside the operating room (46.6%), (p<0.05). As the reason of preference for cesarean delivery, the option of "not putting the baby at risk" is higher among anesthesia professionals than the professionals outside the operating room (p<0.05). As the reason of vaginal delivery, "more physiological", "fear of anesthesia and surgery", "early recovery and desire to breastfeed baby" higher compared to anesthesia professionals (p<0.05).Conclusion: Knowing, practicing and seeing the anesthesia and surgical procedures every day have given the idea that these practices are simple, comfortable and have low risks, so the cesarean delivery rate has increased in anesthesia professionals.

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Impact of recommended changes in labor management for prevention of the primary cesarean delivery

Cited by 79 publications

References 33 publications

The impact of stage of labor on adverse maternal and neonatal outcomes in multiparous women: a retrospective cohort study

The impact of stage of labor on adverse maternal and neonatal outcomes in multiparous women: a retrospective cohort study

Maternal and Neonatal Morbidity after Cesarean Delivery for Active Phase Arrest following Adoption of the Obstetric Care Consensus Guidelines

Comparison of anesthesia professionals' preferences of delivery method with other health professionals

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