Preventing the First Cesarean Delivery

Abstract

With over one-third of pregnancies in the United States being delivered by cesarean and the growing knowledge of morbidities associated with repeat cesarean deliveries, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the Society for Maternal-Fetal Medicine, and the American College of Obstetricians and Gynecologists convened a workshop to address the concept of preventing the first cesarean. The available information on maternal and fetal factors, labor management and induction, and non-medical factors leading to the first cesarean were reviewed as well as the implications of the first cesarean on future reproductive health. Key points were identified to assist with reduction in cesarean rates including that labor induction should be performed primarily for medical indication; if done for non-medical indications, the gestational age should be at least 39 weeks or more and the cervix should be favorable, especially in the nulliparous patient. Review of the current literature demonstrates the importance of adhering to appropriate definitions for failed induction and arrest of labor progress.

Pregnancy in Non-Communicating Unicornuate Uterus: Diagnosis Difficulty and Outcomes – a Case Report

“…Cesarean delivery and its risks are widely debated. According to Spong et al, 10 cesareans are primarily attempted to reduce the overall morbidities related to cesarean delivery. Previous cesarean deliveries increase risks such as uterine rupture, intraoperative complications (placenta previa, accreta, increta, percreta) or adhesions of the uterus, bowel and bladder, for subsequent pregnancies.…”

“…11 Nevertheless, physicians have to consider how long labor induction should be performed in order to avoid a cesarean section. 10 Studies have shown that women undergoing labor induction may remain in the latent phase for at least 6 hours, or for 12 hours or longer in 50% and 20% of the cases respectively. 10 After more than 12 hours of labor induction, there is much debate about whether the procedure should continue or to "rest" the patient with no progress.…”

“…10 Studies have shown that women undergoing labor induction may remain in the latent phase for at least 6 hours, or for 12 hours or longer in 50% and 20% of the cases respectively. 10 After more than 12 hours of labor induction, there is much debate about whether the procedure should continue or to "rest" the patient with no progress. According to Spong et al, 10 when neither the maternal nor the fetal conditions are worsening with time, published trials allowed cervical ripening over a period ranging from a single dose to several doses over two days, despite the fact that this is still a common obstetrical dilemma.…”

Uterine electromyography during active phase compared with latent phase of labor at term

“…Consequently, it could decrease the risk of potentially harmful interventions, such as oxytocin augmentation and epidural analgesia . Moreover, it could help to more accurately diagnose an arrest disorder in the first stage of labor, which depends heavily on accurate diagnosis of active phase of labor .…”

Key Findings from the AWHONN Perinatal Staffing Data Collaborative

“…Patients in any area of a hospital who require 15-minute assessments are considered high acuity and are usually cared for in an intensive care unit. It is difficult to imagine how one nurse can safely and adequately monitor a woman and her fetus(es) every 15 minutes, provide the woman and her family with labor Spong, Berghella, Wenstrom, Mercer, & Saade, 2012). Women on oxytocin are more likely to have medical conditions that put them at greater risk of intrapartum complications.…”