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Can Guidelines Help Lower Rate of Cesarean Delivery?

Am J Obstet Gynecol; ePub 2017 Oct 13; Rosenbloom, et al

Despite significant changes in labor management since the publication of guidelines in 2010 that proposed that the rate of cesarean delivery (CD) could be lowered by avoiding the diagnosis of arrest of dilation before 6 cm, the primary CD rate was not reduced and there has been an increase in maternal and neonatal morbidity, a recent study found. This secondary analysis of a prospective cohort study included 7,845 eligible patients 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. Researchers found:

  • The CD rate was 15.8% in 2019 and 17.7% in 2014.
  • In patients undergoing CD for arrest of dilation, the median cervical dilation at the time of CD was 5.5 cm in 2010 and 6.0 cm in 2014.
  • There was no change in the frequency of patients diagnosed with arrest of dilation at <6 cm; however, the median time spent at the last cervical dilated was 4.0 hours in 2010 and 6.7 hours in 2014.
  • There were 206 CDs for arrest of descent.
  • There was a significant trend towards increasing adverse neonatal and maternal outcomes.

Citation:

Rosenbloom JI, Stout MJ, Tuuli MG, et al. New labor management guidelines and changes in cesarean delivery patterns. [Published online ahead of print October 13, 2017]. Am J Obstet Gynecol. doi:10.1016/j.ajog.2017.10.007.