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Prevention of Primary Cesarean Delivery

Am J Obstet Gynecol; ePub 2017 Dec 29; Thuillier, et al

Implementation of new consensus recommendations for the safe prevention of the primary cesarean delivery (CD) was associated with a reduction of the rate of primary CD performed for arrest of first-stage labor (AoL) with no apparent increase in immediate adverse neonatal outcomes in nulliparous women at term with singleton pregnancies in vertex presentation and with epidural anesthesia. This according to a retrospective cohort study at a university referral hospital that examined the impact of recommended changes in labor management for prevention of the primary CD from the 2014 ACOG/SMF Obstetric Care Consensus statement. Among the findings:

  • The study included 3,283 and 3,068 women in the before and after periods, respectively.
  • The global CD rate decreased significantly from 9.4% in the preguideline to 6.9% in the postguideline period.
  • The CD rate for first-stage AoL dropped in half, but was significant only among nulliparous women.
  • The CD rate for second-stage AoL decreased but not significantly between periods and the CD rate for failure of induction remined similar.

Citation:

Thuillier C, Roy S, Peyronet V, Quibel T, Niandu A, Rozenberg P. Impact of recommended changes in labor management for prevention of the primary cesarean delivery. [Published online ahead of print December 29, 2017]. Am J Obstet Gynecol. doi:10.1016/j.ajog.2017.12.228.