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

Abstract

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

To evaluate rising caesarean section rate and factors contributing to it by using Modified Robson’s Criteria at a tertiary care hospital

“…1 Due to this drastic change in the new era, the complex surgical difficulties faced by an obstetrician has become a dilemma. 2 The overwhelming work at tertiary care centres is making the trainees and obstetricians' life strenuous. The leap seen in placenta accreta spectrum (PAS), rupture uterus and obstetrical hysterectomies has raised maternal morbidity and mortality.…”

Cesarean Delivery Rate in Nulliparous Women in the Second Stage of Labor When Using Zhang Compared With Friedman Labor Curves

“…After studies not relevant to the subject of interest and meeting abstracts were eliminated, nine were retrieved for complete analysis. 5,6,8,[21][22][23][24][25][26] Two studies were excluded: one for including only pregnant women who had a cesarean delivery 21 and one because of the inability to determine from published information the number of cesarean deliveries performed in the second stage of labor. 22 The corresponding author for the latter study was contacted and indicated that they could not provide the additional information requested.…”