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Am J Perinatol 2018; 35(12): 1173-1177
DOI: 10.1055/s-0038-1642063
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

Joshua D. Dahlke
1   Division of Maternal-Fetal Medicine, Methodisth Women's Hospital and Perinatal Center, Omaha, Nebraska
,
Jeffrey D. Sperling
2   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California
,
Phinnara Has
3   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Women and Infants Hospital of Rhode Island, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
,
Todd R. Lovgren
1   Division of Maternal-Fetal Medicine, Methodisth Women's Hospital and Perinatal Center, Omaha, Nebraska
,
Brendan D. Connealy
1   Division of Maternal-Fetal Medicine, Methodisth Women's Hospital and Perinatal Center, Omaha, Nebraska
,
Dwight J. Rouse
3   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Women and Infants Hospital of Rhode Island, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
› Author Affiliations
Further Information

Publication History

09 January 2018

19 March 2018

Publication Date:
24 April 2018 (online)

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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.


 

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