Clinical Edge

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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.


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.