New Labor Management Guidelines and Changes in Cesarean Delivery Patterns

Abstract

Background-In 2010 the Consortium on Safe Labor published labor curves. It was proposed that the rate of cesarean delivery (CD) could be lowered by avoiding the diagnosis of arrest of dilation before 6 cm. However, there is little information on the uptake of the guidelines and on changes in CD rates that may have occurred.Objective-To test the hypotheses that: 1) among patients laboring at term, rates of arrest of dilation disorders have decreased leading to a decrease in the rate of CD; 2) in the second stage, pushing duration prior to diagnosis of arrest of descent has increased also leading to reduction in the rate of CD for this indication. As a secondary aim, we investigated changes in maternal and neonatal morbidity.Study Design-This was a secondary analysis of a prospective cohort study of all patients presenting at ≥ 37 weeks' gestation from 2010-2014 with a non-anomalous vertex singleton and no prior history of CD. Rates of CD, arrest of dilation, and changes in rates of maternal and neonatal morbidity were calculated in crude and adjusted models. Cervical dilation at diagnosis of arrest of dilation, time spent at the maximal dilation prior to diagnosis of arrest of dilation, and time in the second stage prior to diagnosis of arrest of descent were compared over the study period.Results-There were 7845 eligible patients. The CD rate in 2010 was 15.8% and in 2014 17.7% (p-trend 0.51). In patients undergoing CD for arrest of dilation, the median cervical dilation at the time of CD was at 5.5 cm in 2010 and 6.0 cm in 2014 (p-trend 0.94). In these patients, there was an increase in the time spent at last dilation: 3.8h in 2010 to 5.2h in 2014 (p-trend 0.02). There was no change in the frequency of patients diagnosed with arrest of dilation at <6 cm: 51.4% in 2010 and 48.6% in 2014 (p-trend 0.56). However, in these patients, the median time spent at the last

Diagnostic accuracy of the partograph alert and action lines to predict adverse birth outcomes: a systematic review

“…Others have focused on evaluation of the impact of new labour definitions on labour outcomes interventions. Two observational studies conducted in the USA yielded to different findings in terms of frequency of maternal and neonatal morbidity, and reduction of caesarean sections . There is a need to assess the added value of different designs of labour monitoring tools in the improvement of birth outcomes and reduction of unnecessary interventions during labour.…”

“…There is a need to assess the added value of different designs of labour monitoring tools in the improvement of birth outcomes and reduction of unnecessary interventions during labour. This should also include cost‐benefit analysis, considering the potential reduction in unnecessary interventions …”

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

“…The investigators found no difference in CD rate after the guidelines despite the increase in time spent at final cervical dilation from 3.8 hours in 2010 to 5.2 hours in 2014 (p ¼ 0.02). 12 The authors did not assess the rate of compliance with the new guidelines during the study period.…”

“…8 However, during the last 3 years, only a modest decrease of 0.9% has been reported, placing the rate of CD at 32.0% in 2015. 9 Several studies have evaluated the impact of the new guidelines on the primary CD rate, [10][11][12] there is a paucity of data describing adherence to the labor arrest guidelines. Our objective was to evaluate the degree of adherence to consensus guidelines in labor arrest disorders management and to compare outcomes between deliveries considered adherent to the guidelines versus those considered not adherent in a single tertiary center.…”

Updates from the Literature, September/October 2019

“…However, it was not obvious whether the new guidelines would actually result in better outcomes for laboring people and their newborns. Observational studies of hospitals that implemented new guidelines produced contradictory results in terms of cesarean births and perinatal outcomes . Need for randomized clinical trials to evaluate the new guidelines was clear.…”