Lack of Progress in Labor as a Reason for Cesarean

Published in: Obstetrics and Gynecology, v. 95, no. 4, Apr. 2000, p. 589-595

Posted on RAND.org on December 31, 1999

by Deidre S. Gifford, Sally C. Morton, Mary Fiske, Joan Keesey, Emmett B. Keeler, Katherine L. Kahn

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OBJECTIVE: To estimate the prevalence of lack of progress in labor as a reason for cesarean delivery and to compare published diagnostic criteria with the labor characteristics of women with this diagnosis. METHODS: The authors reviewed medical records and did a postpartum telephone survey to collect data from 733 women who delivered full-term, nonbreech infants by unplanned cesarean between March 1993 and February 1994. These were a subset of 2447 births sampled at delivery from 30 hospitals in Los Angeles County and Iowa. The authors measured the proportion of unplanned cesareans done for lack of progress in labor, the cervical dilatation at the time of cesarean, length of the second stage, and slope of the active phase among the women. They estimated the proportion of these cesareans that conformed to the ACOG criteria for the diagnosis of lack of progress. Results: Lack of progress was a reason for 68% of unplanned, vertex cesareans. At least 16% of the subjects who had cesareans for lack of progress were in the latent phase of labor according to ACOG criteria. The second stage was not prolonged in 36% of the women who delivered at 10 cm. Conclusion: Lack of progress in labor is a dominant reason for cesarean delivery. Many cesareans are done during the latent phase of labor, and in the second stage of labor when it is not prolonged. These practices do not conform to published diagnostic criteria for lack of progress.

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