Peripartum Morbidity after Cesarean Delivery for Arrest of Dilation at 4 to 5 cm Compared with 6 to 10 cm

Abstract

Objective Given that recent consensus guidelines established to decrease cesarean delivery (CD) rates use 6 cm to define the onset of the active phase of labor, our objective was to evaluate maternal and neonatal outcomes after CD for the indication of arrest of dilation at 4 to 5 cm compared with ≥ 6 cm.

Study Design We performed a secondary analysis using data from the Maternal Fetal-Medicine Units Network Cesarean Registry. We included nulliparous women with term, singleton, vertex gestations who underwent primary CD for arrest of dilation. We compared those who reached a maximum cervical dilation of 4 to 5 cm with those of ≥6 cm. Our primary outcome was composite maternal morbidity that included chorioamnionitis, endometritis, transfusion, wound complication, operative injury, intensive care unit admission, or death.

Results Of the 73,257 women in the dataset, 5,681 met the inclusion criteria. After adjusting for confounders, there was no difference in composite maternal (adjusted odds ratio [aOR]: 1.19; 95% confidence interval [CI]: 0.94–1.52) or neonatal morbidity (aOR: 0.94; 95% CI: 0.79–1.10) between the groups.

Conclusion In this historical cohort, maternal and neonatal outcomes after CD for arrest of dilation ≥ 6 cm were comparable to those performed at 4 to 5 cm and support recent labor management guidelines.

Keywords

cesarean - arrest of dilation - maternal morbidity - neonatal morbidity

Condensation

In a historical cohort, peripartum outcomes in nulliparous were comparable after CD for arrest of dilation at 4 to 5 cm and ≥6 cm.

Note

These findings were presented at the 2017 Society for Maternal Fetal Medicine's 37th Annual Pregnancy Meeting, January 23–28, Las Vegas, NV.

• References

• 1 FastStats Hospital Utilization. Center for Disease Control and Prevention. National Center for Health Statistics Available at: http://www.cdc gov/nchs/fastats/inpatient-surgery.htm . Accessed December, 2014
• 2 National Institute for Health Care and Excellence. Antenatal care for uncomplicated pregnancies. NICE Clinical Guidelines. Updated edition. London 2008. Available at: https://www.ncbi.nlm.nih.gov/books/NBK115309/ . Updated January 2017. Accessed December, 2014
• 3 National Collaborating Centre for Women's and Children's Health (UK). Caesarean section. London: RCOG Press; 2011 (NICE Clinical Guidelines, No. 132.) Available at: https://www.ncbi.nlm.nih.gov/books/NBK115309/ . Accessed December, 2014
• 4 Zhang J, Landy HJ, Branch DW. , et al; Consortium on Safe Labor. Contemporary patterns of spontaneous labor with normal neonatal outcomes. Obstet Gynecol 2010; 116 (06) 1281-1287
• 5 U.S Department of Health and Human Services. Healthy people 2020. 2000. Available at: https://www.healthypeople.gov/2020/topics-objectives/topic/maternal-infant-and-child-health/objectives . Accessed January 2018
• 6 Caughey AB, Cahill AG, Guise J-M, Rouse DJ. ; American College of Obstetricians and Gynecologists (College); Society for Maternal-Fetal Medicine. Safe prevention of the primary cesarean delivery. Am J Obstet Gynecol 2014; 210 (03) 179-193
• 7 Spong CY, Berghella V, Wenstrom KD, Mercer BM, Saade GR. Preventing the first cesarean delivery: summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, and American College of Obstetricians and Gynecologists Workshop. Obstet Gynecol 2012; 120 (05) 1181-1193
• 8 Cohen WR, Friedman EA. Perils of the new labor management guidelines. Am J Obstet Gynecol 2015; 212 (04) 420-427
• 9 Chauhan SP, Beydoun H, Hammad IA. , et al. Indications for caesarean sections at ≥34 weeks among nulliparous women and differential composite maternal and neonatal morbidity. BJOG 2014; 121 (11) 1395-1402
• 10 Landon MB, Leindecker S, Spong CY. , et al; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. The MFMU Cesarean Registry: factors affecting the success of trial of labor after previous cesarean delivery. Am J Obstet Gynecol 2005; 193 (3 Pt 2): 1016-1023
• 11 Wilson-Leedy JG, DiSilvestro AJ, Repke JT, Pauli JM. Reduction in the cesarean delivery rate after obstetric care consensus guideline implementation. Obstet Gynecol 2016; 128 (01) 145-152