Safe prevention of the primary cesarean delivery

Caughey, Aaron B.; Cahill, Alison G.; Guise, Jeanne Marie; Rouse, Dwight J.

doi:10.1016/j.ajog.2014.01.026

Cited by 962 publications

(428 citation statements)

References 102 publications

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“…Although the commonly agreed point of onset of accelerative labour is 4 cm, as popularised by the start of the partograph alert line, our review suggests that labour may indeed not begin to accelerate substantially until 6 cm in a considerable proportion of women. This observation from one of the studies in this review was used as the basis for the recent American College of Obstetricians and Gynaecologists’ (ACOG) recommendation that standards of care for the active phase of labour should only be applied when women have reached a 6‐cm threshold 6, 11. The patterns observed in the individual studies included in our review and the aggregated estimates provide even more robust evidence in support of this recommendation.…”

Section: Discussionmentioning

confidence: 61%

“…The call for women‐centred approaches to reduce labour and childbirth interventions, particularly primary CS, has renewed interest in a better understanding of natural labour progression 10, 11. This has become more critical because of the variations in current labour practices and the characteristics of pregnant women compared with when Friedman conducted his studies 12.…”

Section: Introductionmentioning

confidence: 99%

“…An important derivative of Friedman's work—the ‘1‐cm/hour’ alert line of the partograph—has come under intense scrutiny as a result of studies suggesting that labour can indeed be slower than the limits earlier proposed 6, 7, 13. Studies published in the last decade on ‘natural’ labour progression have prompted a few international organisations to revise their labour management guidelines to accommodate a cervical dilatation rate slower than 1 cm/hour as the normal threshold 11, 14. In spite of these developments, several obstetric textbooks and international guidelines still maintain 1 cm/hour as the minimum dilatation threshold that should be expected in all women 15, 16.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Cervical dilatation patterns of ‘low‐risk’ women with spontaneous labour and normal perinatal outcomes: a systematic review

Oladapo

Díaz

Bonet

et al. 2017

BJOG

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BackgroundThe call for women‐centred approaches to reduce labour interventions, particularly primary caesarean section, has renewed an interest in gaining a better understanding of natural labour progression.ObjectiveTo synthesise available data on the cervical dilatation patterns during spontaneous labour of ‘low‐risk’ women with normal perinatal outcomes.Search strategyPubMed, EMBASE, CINAHL, POPLINE, Global Health Library, and reference lists of eligible studies.Selection criteriaObservational studies and other study designs.Data collection and analysisTwo authors extracted data on: maternal characteristics; labour interventions; the duration of labour centimetre by centimetre; and the duration of labour from dilatation at admission through to 10 cm. We pooled data across studies using weighted medians and employed the Bootstrap‐t method to generate the corresponding confidence bounds.Main resultsSeven observational studies describing labour patterns for 99 971 women met our inclusion criteria. The median time to advance by 1 cm in nulliparous women was longer than 1 hour until a dilatation of 5 cm was reached, with markedly rapid progress after 6 cm. Similar labour progression patterns were observed in parous women. The 95th percentiles for both parity groups suggest that it was not uncommon for some women to reach 10 cm, despite dilatation rates that were much slower than the 1‐cm/hour threshold for most part of their first stage of labours.ConclusionAn expectation of a minimum cervical dilatation threshold of 1 cm/hour throughout the first stage of labour is unrealistic for most healthy nulliparous and parous women. Our findings call into question the universal application of clinical standards that are conceptually based on an expectation of linear labour progress in all women.Funding UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, and the United States Agency for International Development (USAID).Tweetable abstractCervical dilatation threshold of 1 cm/hour throughout labour is unrealistic for most women, regardless of parity.

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Section: Discussionmentioning

confidence: 61%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Cervical dilatation patterns of ‘low‐risk’ women with spontaneous labour and normal perinatal outcomes: a systematic review

Oladapo

Díaz

Bonet

et al. 2017

BJOG

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“…Many initiatives have been undertaken to decrease the rate of primary CS, but the mean CS rate in developed countries is still high (approximately 30%) [1,3,4]. Thus, the population of women who have undergone a primary CS is growing rapidly each year.…”

Section: Introductionmentioning

confidence: 99%

Morphology of the cesarean section scar in the non-pregnant uterus after one elective cesarean section

Pomorski¹,

Fuchs²,

Rosner-Tenerowicz³

et al. 2017

Ginekol Pol

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Objectives: A growing number of studies suggest that the incomplete healing of the CS scar in the uterus increase the risk of uterine dehiscence or rupture during subsequent pregnancies. Thus, the factors that affect wound healing should be evaluated. We aimed to determine whether the morphology of the CS scar in non-pregnant women after one elective CS was affected by the site of the uterine incision, uterine flexion, maternal age, and fetal birth weight. Material and methods:208 non-pregnant women were invited for participation in the study, but only 101 of them met inclusion criteria. Standardized scar parameters (residual myometrial thickness (RMT), depth (D) and width (W) of the hypoechoic niche) were measured using ultrasonography at least 6 weeks after the CS.Results: Scar defect was detected in 26 of 101 subjects. Women without scar defect had significantly higher RMT values (1.87 vs. 0.87), lower newborn birth weight (3127 g vs. 3295 g), and higher scar location above the internal cervical os (62% vs. 16%), than those with scar defect. Maternal age was significantly correlated with D value (R = 0.40). Uterine retroflexion was significantly correlated with a larger D value (R = 0.63) and a larger D/RMT ratio (R = 0.24). Conclusions:In low-risk women who have undergone one elective CS, several risk factors are associated with development of the scar defect, but only scar location can be modified during surgery. Future research is needed to determine whether a relatively higher incision location in the uterus can ensure optimal healing of the CS scar.

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“…Clear guidelines to regulate the factors that necessitate admission in early labor could have a significant impact on the CB rate. This is supported by the recently published American Congress of Obstetrics and Gynecology consensus statement that promotes certain strategies to decrease primary cesarean, including allowing women more time in early labor, defining active labor as 6 cm dilatation, and allowing women more time in the second stage of labor [31] . Despite clinical recommendations such as those, it is unlikely that CB rates will decrease without further research on the use of combinations of interventions as related to birth outcomes.…”

Section: Discussionmentioning

confidence: 71%

Place, provider and timing: Factors influencing the overuse of cesarean in low-risk primigravid women

Regan

McElroy

Chung

et al. 2014

JNEP

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The purpose of this study was to examine the relationship between the type and timing of commonly used intrapartum clinical factors and their relationship to birth outcomes. The factors included in the analysis were type of provider (midwife or obstetrician), place of birth (home or hospital), cervical dilation on admission, and commonly used labor interventions, namely use of continuous electronic fetal monitoring, epidural anesthesia and oxytocin on the type of birth (cesarean or vaginal birth). The research question guiding the analysis was: what factors increase the likelihood of cesarean birth (CB)? The findings reported here are parts of a larger mixed methods study that used three data collection methods: a projective test, a focus group, and a semi-structured postpartum interview. The study took place in an urban area in the mid-Atlantic United States and the sample was comprised of 49 low-risk primigravid women recruited between 28-36 weeks gestation. The analysis reported here only used data from the postpartum interview. During the interview, each woman reported the events of their labor and birth that were then mapped along a timeline. The findings show that admission to hospital early in labor played a key role in increasing the number of interventions used and was associated with increased risk of CB. The small, homogenous sample limited the ability to conduct more comprehensive statistical analysis and to generalize to more diverse groups, however, the proportional differences are highly suggestive and warrant further investigation.

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Safe prevention of the primary cesarean delivery

Cited by 962 publications

References 102 publications

Cervical dilatation patterns of ‘low‐risk’ women with spontaneous labour and normal perinatal outcomes: a systematic review

Cervical dilatation patterns of ‘low‐risk’ women with spontaneous labour and normal perinatal outcomes: a systematic review

Morphology of the cesarean section scar in the non-pregnant uterus after one elective cesarean section

Place, provider and timing: Factors influencing the overuse of cesarean in low-risk primigravid women

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