Adherence to Consensus Guidelines for the Management of Labor Arrest Disorders in a Single Academic Tertiary Care Medical Center

Abstract

Objective To evaluate the degree of adherence to the new the American College of Obstetricians and Gynecologists/Society for Maternal–Fetal Medicine guidelines in labor arrest management. Study Design A retrospective study of term, live, singleton deliveries with intrapartum primary cesarean delivery solely for failed induction of labor or labor arrest. Adherence was defined according to the Safe Prevention of the Primary Cesarean Delivery 2014 criteria. We evaluated adherence and compared maternal and perinatal outcomes, delivery time frame, and billing provider. Multivariable Poisson regression models with robust error variance were used to calculate adjusted relative risk (aRR) and 95% confidence interval (CI). Results Two-hundred six deliveries met the inclusion criteria; 73% were deemed not adherent to the guidelines. The majority of cases were under the care of nonacademic private practice OB/GYN physicians. The adherence rate was higher in the active phase of labor (45%) than in second stage (17%) and latent phase (14%). There were no differences in perinatal outcomes between the two groups. The adherence to guidelines was higher among academic OB/GYN physicians (aRR, 2.24, 95% CI, 1.49–3.36) and during the weekday–night shift (aRR, 1.81, 95% CI, 1.10–2.98). Conclusion Despite recent guidelines aimed to reduce the primary cesarean delivery rate, most cesarean deliveries performed for labor arrest disorders were not adherent to the guidelines.

Racial and Ethnic Disparities in Primary Cesarean Birth and Adverse Outcomes Among Low-Risk Nulliparous People

“…First, we focused on low-risk nulliparous individuals, compared with all individuals who delivered irrespective of parity or comorbidity. 15,36 Second, in addition to the differential rate of cesarean birth, we reported on composite neonatal and maternal adverse outcomes and infant mortality. Third, with the population-based study, the sample size permitted us to assess the association with uncommon adverse outcomes (eg, seizure, hysterectomy) while controlling for multiple potential confounders.…”

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

“…10 Adherence to guidelines may also vary, even within institutions with published nonadherence rates as high as 73%. 11 There are some limitations to our study. The retrospective design is inherently susceptible to coding errors or missing data that may have biased our findings.…”

“…10 Adherence to guidelines may also vary, even within institutions with published nonadherence rates as high as 73%. 11…”

“…Indeed, this is supported by Alrais et al, who found that academic physicians were twice as likely to be adherent to the guidelines in a heterogenous physician population. 11 Furthermore, a quorum of physicians lends itself to consistency of practice, which will reduce practice variation in the application of standards and definitions.…”

“…Components of the CMM in patients with arrest of descentOutcomes of Primary Cesarean Delivery for Arrest of Labor Jalloul et al 55 also vary, even within institutions with published nonadherence rates as high as 73% 11. …”