STATION AT ONSET OF ACTIVE PHASE IN NULLIPAROUS PATIENTS AND RISK OF CESAREAN DELIVERY

Objective To evaluate whether the use of a peanut ball device shortens the duration of active labor in nulliparas. Study Design Single-site, nonblinded randomized trial in nulliparous women admitted for labor or labor induction. English-speaking women > 18 years of age with singleton pregnancies were enrolled. Participants were randomized to the use of peanut ball or usual care upon reaching the active phase of labor (≥ 6 cm cervical dilation) with an epidural. Primary outcome was rate of cervical dilation. Secondary outcomes were rates of cesarean delivery and fetal presentation at time of full dilation or delivery. Results Ninety-six patients enrolled; 63 reached full cervical dilation. There was no statistically significant difference in rates of cervical dilation (0.98cm/h vs. 0.79cm/h, p = 0.27) or length of labor (315 minutes vs. 387 minutes, p = 0.14) between the groups. There was no difference in the rates of cesarean delivery (33% vs. 35%, p = 0.8) or occiput posterior presentation. (28% vs. 9%, p = 0.09). Among the subgroup who had labor arrest, fewer patients using the peanut ball experienced arrest of dilation; this approached but did not reach statistical significance (30% vs. 73% p = 0.05). Conclusion Use of the peanut ball does not significantly increase rates of cervical dilation or decrease time in active labor.

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Adherence to Consensus Guidelines for the Management of Labor Arrest Disorders in a Single Academic Tertiary Care Medical Center

American Journal of Perinatology ◽

10.1055/s-0038-1675154 ◽

2018 ◽

Vol 36 (09) ◽

pp. 911-917 ◽

Cited By ~ 1

Author(s):

Mesk A. Alrais ◽

Nana-Ama E. Ankumah ◽

Farah H. Amro ◽

Tyisha Barrett ◽

Kendra Folh ◽

...

Keyword(s):

Cesarean Delivery ◽

Medical Center ◽

Tertiary Care ◽

Night Shift ◽

Perinatal Outcomes ◽

Active Phase ◽

Adherence Rate ◽

Adjusted Relative Risk ◽

Tertiary Care Medical Center ◽

Primary Cesarean Delivery

Objective To evaluate the degree of adherence to the new the American College of Obstetricians and Gynecologists/Society for Maternal–Fetal Medicine guidelines in labor arrest management. Study Design A retrospective study of term, live, singleton deliveries with intrapartum primary cesarean delivery solely for failed induction of labor or labor arrest. Adherence was defined according to the Safe Prevention of the Primary Cesarean Delivery 2014 criteria. We evaluated adherence and compared maternal and perinatal outcomes, delivery time frame, and billing provider. Multivariable Poisson regression models with robust error variance were used to calculate adjusted relative risk (aRR) and 95% confidence interval (CI). Results Two-hundred six deliveries met the inclusion criteria; 73% were deemed not adherent to the guidelines. The majority of cases were under the care of nonacademic private practice OB/GYN physicians. The adherence rate was higher in the active phase of labor (45%) than in second stage (17%) and latent phase (14%). There were no differences in perinatal outcomes between the two groups. The adherence to guidelines was higher among academic OB/GYN physicians (aRR, 2.24, 95% CI, 1.49–3.36) and during the weekday–night shift (aRR, 1.81, 95% CI, 1.10–2.98). Conclusion Despite recent guidelines aimed to reduce the primary cesarean delivery rate, most cesarean deliveries performed for labor arrest disorders were not adherent to the guidelines.

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Occiput-spine angle and prediction of cesarean delivery in protracted active phase of labor: occiput position does matter.

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2021.08.009 ◽

2021 ◽

Author(s):

Andrea Dall’Asta ◽

Giuseppe Rizzo ◽

Bianca Masturzo ◽

Tullio Ghi

Keyword(s):

Cesarean Delivery ◽

Active Phase

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Oxytocin Discontinuation During Induced Labor in Pregnancies With Suspected Fetal Growth Restriction

10.21203/rs.3.rs-99981/v1 ◽

2020 ◽

Author(s):

Sayuri Iwai ◽

Kazuya Mimura ◽

Masayuki Endo ◽

Yoko Kawanishi ◽

Aiko Kakigano ◽

...

Keyword(s):

Cesarean Delivery ◽

Fetal Growth ◽

Fetal Growth Restriction ◽

Active Phase ◽

Labor Induction ◽

Growth Restriction ◽

Labor Management ◽

Induced Labor ◽

Increased Risk ◽

Oxytocin Infusion

Abstract Objective: Although fetal growth restriction (FGR) is associated with an increased risk of cesarean delivery during induced labor, there is little evidence to guide labor management in such cases. This study aimed to investigate whether discontinuation of oxytocin infusion affects the cesarean delivery rate and the risk of maternal and neonatal complications associated with induced labor in pregnancies with suspected FGR.Methods: This was a retrospective cohort study of singleton pregnancies with vertex presentation and indications for labor induction due to FGR after 34.0 weeks of gestation at our institution from January 2010 to December 2017. Two parallel groups were compared: women who received oxytocin continuously until delivery (continuation group) and women whose oxytocin was discontinued at the beginning of the active phase of labor (discontinuation group).Results: There were 74 women in the continuation group and 51 women in the discontinuation group. The incidence of cesarean deliveries was higher (5.4% vs 2.0%) in the continuation group, but this difference was not statistically significant. However, the incidence of uterine tachysystole (23.0% vs 9.8%) was significantly higher in the continuation group than in the discontinuation group. Differences in labor management did not affect the lengths of the active phase and second stage of labor (mean, 136 ± 122 minutes and 34.2 ± 45 minutes, respectively; 122 ± 104 minutes and 48.8±67 minutes in the continuation group and discontinuation group, respectively). The incidence of postpartum hemorrhage and adverse neonatal outcomes were not significantly different between groups.Conclusions: Oxytocin can be safely discontinued after the active phase of labor in women undergoing labor induction for FGR without an increased risk of cesarean delivery or other unfavorable outcomes. Therefore, this strategy may be considered an alternative to continued oxytocin infusion.

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Reducing neonatal morbidity by discontinuing oxytocin during the active phase of first stage of labor: a multicenter randomized controlled trial STOPOXY

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03331-x ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Aude Girault ◽

◽

François Goffinet ◽

Camille Le Ray

Keyword(s):

Cesarean Delivery ◽

Postpartum Hemorrhage ◽

Primary Outcome ◽

Controlled Trial ◽

Neonatal Morbidity ◽

Active Phase ◽

Maternal Complications ◽

Multicenter Randomized Controlled Trial ◽

The Impact ◽

First Stage Of Labor

Abstract Background Oxytocin is effective in reducing labor duration, but can be associated with fetal and maternal complications such as neonatal acidosis and post-partum hemorrhage. When comparing discontinuing oxytocin in the active phase with continuing oxytocin infusion, previous studies were underpowered to show a reduction in neonatal morbidity. Thus, we aim at evaluating the impact of discontinuing oxytocin during the active phase of the first stage of labor on the neonatal morbidity rate. Methods STOPOXY is a multicenter, randomized, open-label, controlled trial conducted in 20 maternity units in France. The first participant was recruited January 17th 2020. The trial includes women with a live term (≥37 weeks) singleton, in cephalic presentation, receiving oxytocin before 4 cm, after an induced or spontaneous labor. Women aged < 18 years, with a lack of social security coverage, a scarred uterus, a multiple pregnancy, a fetal congenital malformation, a growth retardation <3rd percentile or an abnormal fetal heart rate at randomization are excluded. Women are randomized before 6 cm when oxytocin is either continued or discontinued. Randomization is stratified by center and parity. The primary outcome, neonatal morbidity is assessed using a composite variable defined by an umbilical arterial pH at birth < 7.10 and/or a base excess > 10 mmol/L and/or umbilical arterial lactates> 7 mmol/L and/or a 5 min Apgar score < 7 and/or admission in neonatal intensive care unit. The primary outcome will be compared between the two groups using a chi-square test with a p-value of 0.05. Secondary outcomes include neonatal complications, duration of active phase, mode of delivery, fetal and maternal complications during labor and delivery, including cesarean delivery rate and postpartum hemorrhage, and birth experience. We aim at including 2475 women based on a reduction in neonatal morbidity from 8% in the control group to 5% in the experimental group, with a power of 80% and an alpha risk of 5%. Discussion Discontinuing oxytocin during the active phase of labor could improve both child health, by reducing moderate to severe neonatal morbidity, and maternal health by reducing cesarean delivery and postpartum hemorrhage rates. Trial registration Clinical trials NCT03991091, registered June 19th, 2019.

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Risk of Cesarean Delivery for Women with Obesity Using a Standardized Labor Induction Protocol

American Journal of Perinatology ◽

10.1055/s-0041-1732459 ◽

2021 ◽

Author(s):

Rebecca F. Hamm ◽

Christina P. Teefey ◽

Cara D. Dolin ◽

Celeste P. Durnwald ◽

Sindhu K. Srinivas ◽

...

Keyword(s):

Cesarean Delivery ◽

Prospective Trial ◽

Secondary Analysis ◽

Active Phase ◽

Labor Induction ◽

Adjusted Relative Risk ◽

Labor Management ◽

Increased Risk ◽

Unfavorable Cervix ◽

Failed Induction

Objective We aimed to determine the risk of cesarean among women with obesity undergoing labor induction within a prospective trial that utilized a standardized labor protocol. Study Design This was a secondary analysis of a randomized trial of induction methods. Term (≥37 weeks) women with intact membranes undergoing induction with an unfavorable cervix (Bishop's score ≤6 and dilation ≤2 cm) were included. The trial utilized a labor protocol that standardized induction and active labor management, with recommendations for interventions at particular time points. Only women with a recorded body mass index (BMI) at prenatal care start were included in this analysis. The primary outcome was cesarean delivery compared between obese (≥30 kg/m2) and nonobese (<30 kg/m2) women. Indication for cesarean was also evaluated. Results A total of 465 women were included: 207 (44.5%) obese and 258 (55.5%) nonobese. Women with obesity had a higher risk of cesarean compared with women without obesity (33.3 vs. 23.3%, p = 0.02), even when adjusting for parity, weight change over pregnancy, and indication for induction (adjusted relative risk [aRR] = 1.79, 95% confidence interval [CI]: [1.34–2.39]). Compared with women without obesity, women with obesity had a higher risk of failed induction (47.8 vs. 26.7%, p = 0.01) without a difference in arrest of active phase (p = 0.39), arrest of descent (p = 0.95) or fetal indication (p = 0.32), despite adherence to a standardized labor protocol. Conclusion Compared with women without obesity, women with obesity undergoing an induction are at increased risk of cesarean, in particular a failed induction, even within the context of standardized induction management. As standardized practices limit provider variation in labor management, this study may support physiologic differences in labor processes secondary to obesity. Key Points

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Racial Disparities in the Rates of and Indications for Cesarean Delivery in California: Are They Changing Over Time?

American Journal of Perinatology ◽

10.1055/s-0041-1740071 ◽

2021 ◽

Author(s):

E. Nicole Teal ◽

Kelechi Anudokem ◽

Rebecca J. Baer ◽

Laura Jelliffe-Pawlowski ◽

Biftu Mengesha

Keyword(s):

Racial Disparities ◽

Cesarean Delivery ◽

Placenta Previa ◽

Birth Certificate ◽

Active Phase ◽

International Classification Of Diseases ◽

Birth Certificates ◽

Obstetric Outcomes ◽

Adjusted Relative Risk ◽

Black And White

Objective: The aim of this study was to assess whether racial disparities in rates of and indications for cesarean delivery (CD) between non-Hispanic Black and non-Hispanic White birthing people in California changed from 2011 to 2017. Methods: This was a retrospective cohort study using a database of birth certificates linked to discharge records. Singleton term live births in nulliparous Black and White birthing people in California between 2011 and 2017 were included. Those with noncephalic presentation, placenta previa, and placenta accreta were excluded. CD rate and indication were obtained from birth certificate variables and International Classification of Diseases codes. Differences in CD rate and indication were calculated for Black versus White individuals using univariable and multivariable logistic regression and adjusted for potential confounders. Results: A total of 348,144 birthing people were included, 46,361 Black and 301,783 White. Overall, 30.9% of Black birthing people underwent CD compared with 25.3% of White (adjusted relative risk [aRR]: 1.2, 95% confidence interval [CI]: 1.2–1.3). From 2011 to 2017, the CD rate fell 11% (26.4–23.7%, p < 0.0001) for White birthing people and 1% for Black birthing people (30.4–30.1%, p = 0.037). Over the study period, Black birthing people had a persistent 1.2- to 1.3-fold higher risk of CD and were persistently more likely to undergo CD for fetal intolerance (aRR: 1.1, 95% CI: 1.1–1.2) and less likely for active phase arrest or arrest of descent (aRRs: 0.9 and 0.4; 95% CIs: 0.9–0.9 and 0.3–0.5). Conclusion: The CD rate decreased substantially for White birthing people and minimally for Black birthing people in our cohort over the study period. Meanwhile, disparities in CD rate and indications between the two groups persisted, despite controlling for confounders. Although care bundles for reducing CD may be effective among White birthing people, they are not associated with reduction in CD rates among Black birthing people nor improvements in racial disparities between Black and White birthing people. Precis: Despite increasing attention to racial inequities in obstetric outcomes, there were no changes in disparities in CD rates or indications in California from 2011 to 2017. Key Points

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Continuous intrapartum support to reduce primary cesarean

10.21203/rs.2.15896/v1 ◽

2019 ◽

Author(s):

Luz Maria Cardona-Torres ◽

Rafael Leyva-Jimenez

Keyword(s):

Cesarean Delivery ◽

Group Versus ◽

Active Phase ◽

World Health ◽

Delivery Rate ◽

Control Group ◽

Study Group ◽

Professional Nurse ◽

Average Percentage ◽

Cesarean Delivery Rate

Abstract Background The average percentage of births by cesarean section worldwide in 2014 was 18.6% (range: 1.4% to 56.4%), and in Latin America and the Caribbean 40.5% [range: 5.5% - 55.6%]. In Mexico, the cesarean delivery rate remained above 40% in the period from 2008 to 2015, and without signs of decreasing, the World Health Organization recommends up to 15% maximum. The objective of the study was to decrease the rate of deliveries by cesarean, through continuous intrapartum support during the active phase until birth.Methods Experimental study, open label, carried out in a public health institution in Mexico, during July-December 2018, with a study population of N = 115 women in labor (nulliparous, term, singleton, vertex) and under 40 years old, was formed a control group (n = 55) who received routine maternity care and a study group (n = 60), who received continuous intrapartum support during the active phase until birth by a professional nurse with a university degree.Results In the study group, the cesarean delivery rate was 1.7% (1 of 60), significantly lower than that of the control group, which was 29.1% (16 of 55) [X 2 = 17.13, df = 1, N = 115, p < .001], with a risk ratio of 0.06 (95% CI: 0.01 to 0.42), the absolute risk reduction was 27.4%, (95% CI: 15% to 40%), also, the hours of labour were significantly lower with a median of 6.7 hours in the study group versus a median of 13.4 hours in the control group,Conclusion Continuous intrapartum support provided by a professional nurse in the active phase helps to reduce the rate of cesarean deliveries, as well as to reduce the time of labour in women (nulliparous, term, singleton, vertex) under 40 years of age.

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