Abstract
Objective The cesarean delivery rate in the United States is 31.9%. One of the leading indications
for primary cesarean delivery is labor arrest. A modern understanding of the labor
curve supports more time prior to the diagnosis of labor arrest. We conducted this
study to examine the impact of adherence to the modern criteria for labor arrest and
failed induction on rates of primary cesarean delivery and to identify predictors
of meeting these criteria.
Study Design We analyzed rates of primary cesarean deliveries overall and primary cesarean deliveries
occurring due to arrest of dilation, arrest of descent, and failed induction among
the 17,877 live births at a large academic center from 2010 through 2013. Multiple
logistic regression modeling identified predictors of meeting the new criteria for
these indications based on guidelines published by the 2012 National Institute of
Child Health and Human Development.
Results The primary cesarean delivery rate decreased from 23.5 to 21.1% (p = 0.026) from 2010 to 2013. Primary cesarean delivery rate for labor arrest and failed
induction decreased from 8.5 to 6.7% (p = 0.005). The percentage of primary cesarean deliveries meeting the 2012 criteria
for labor arrest increased from 18.8 to 34.9% (p = 0.002), and the rate of primary cesarean deliveries due to arrest of dilation decreased
from 5.1 to 3.4% (p < 0.0005). The percentage of cases meeting the 2012 criteria for arrest of descent
increased from 57.8 to 71.0% (p < 0.007), while primary cesarean delivery rate due to arrest of descent remained
relatively unchanged, 3.1 to 2.6% (p = 0.330).
Conclusion A decrease in the primary cesarean rate was attributable to a decrease in cesarean
for arrest of dilation in the setting of a significant increase in meeting the 2012
criteria for arrest of dilation. At the end of the study period, 65.2% of cesareans
still did not meet the criteria for arrest of dilation. Greater rates of adherence
to these guidelines may yield further reductions in the cesarean rate.
Key Points
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Primary cesarean delivery for labor arrest was decreased.
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Meeting criteria for labor arrest increased.
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A hospitalist provider increased odds of meeting criteria.
Keywords
arrest of descent - arrest of dilation - failed induction of labor - labor arrest
- labor curve - primary cesarean delivery - indication for cesarean delivery
