Labor Dystocia: A Common Approach to Diagnosis

Abstract

Contemporary labor and birth population norms should be the basis for evaluating labor progression and determining slow progress that may benefit from intervention. The aim of this article is to present guidelines for a common, evidence-based approach for determination of active labor onset and diagnosis of labor dystocia based on a synthesis of existing professional guidelines and relevant contemporary publications. A 3-point approach for diagnosing active labor onset and classifying labor dystocia-related labor aberrations into well-defined, mutually exclusive categories that can be used clinically and validated by researchers is proposed. The approach comprises identification of 1) an objective point that strictly defines active labor onset (point of active labor determination); 2) an objective point that identifies when labor progress becomes atypical, beyond which interventions aimed at correcting labor dystocia may be justified (point of protraction diagnosis); and 3) an objective point that identifies when interventions aimed at correcting labor dystocia, if used, can first be determined to be unsuccessful, beyond which assisted vaginal or cesarean birth may be justified (earliest point of arrest diagnosis). Widespread adoption of a common approach for diagnosing labor dystocia will facilitate consistent evaluation of labor progress, improve communications between clinicians and laboring women, indicate when intervention aimed at speeding labor progress or facilitating birth may be appropriate, and allow for more efficient translation of safe and effective management strategies into clinical practice. Correct application of the diagnosis of labor dystocia may lead to a decrease in the rate of cesarean birth, decreased health care costs, and improved health of childbearing women and neonates.

Likelihood of cesarean delivery after applying leading active labor diagnostic guidelines

“…Determining active labor onset at the individual level, based on cervical change over time, will result in active labor diagnoses before 6 cm in some women, as we found in our study. This would allow for earlier identification and treatment of dystocia, a diagnosis made only in active labor or second stage labor . Conversely, use of the ACOG/SMFM guideline would limit diagnosis and treatment of dystocia until after 6 cm dilatation; however, the effect on maternal and neonatal outcomes may not yet be fully understood.…”

Applying a physiologic partograph to Consortium on Safe Labor data to identify opportunities for safely decreasing cesarean births among nulliparous women

“…[6][7][8]22 Accurate diagnosis of dystocia likely provides the best opportunity to prevent primary cesarean births and this diagnosis can only be appropriately made after a woman has entered active labor. 23 We are at a practice crossroads, wherein we know that many women with normal labor progression undergo potentially unnecessary cesarean birth simply because active labor onset and labor dystocia are diagnosed in some women whose labor progress does not meet recommended criteria.…”

The ARRIVE Trial: Interpretation from an Epidemiologic Perspective

“…For example, all hospitals in the study adhered to a common definition of unsuccessful labor induction in the latent phase of labor, and once in the active phase followed American College of Obstetricians and Gynecologists–SMFM guidelines for diagnosis of labor arrest and descent disorders . It is possible that in the absence of such practice guidelines, an increased frequency of labor induction, with concomitant longer mean labor duration, would result in a higher cesarean birth rate because of increased diagnoses of labor dystocia and labor arrest . More information about how these labor management considerations compare with most US hospitals, and how the differences could translate to variability in perinatal outcomes, will help in assessing the generalizability of the ARRIVE results.…”