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

Mesk A. Alrais; Nana-Ama E. Ankumah; Farah H. Amro; Tyisha Barrett; Kendra Folh; Han-Yang Chen; Baha M. Sibai; Sean C. Blackwell

doi:10.1055/s-0038-1675154

American Journal of Perinatology, Table of Contents

Am J Perinatol 2019; 36(09): 911-917
DOI: 10.1055/s-0038-1675154

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

Mesk A. Alrais

¹Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas

,

Nana-Ama E. Ankumah

¹Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas

,

Farah H. Amro

²Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas

,

Tyisha Barrett

²Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas

,

Kendra Folh

³Texas Medical Center, Children's Memorial Hermann Hospital, Houston, Texas

,

Han-Yang Chen

¹Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas

,

Baha M. Sibai

¹Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas

,

Sean C. Blackwell

¹Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas

› Author Affiliations

Abstract

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.

Keywords

adherence - cesarean delivery - consensus guidelines - failed induction - labor arrest

Full Text

References

References
1 Kozhimannil KB, Arcaya MC, Subramanian SV. Maternal clinical diagnoses and hospital variation in the risk of cesarean delivery: analyses of a National US Hospital Discharge Database. PLoS Med 2014; 11 (10) e1001745
2 American College of Obstetricians and Gynecologists; Society for Maternal-Fetal Medicine. Obstetric care Consensus No. 1: Safe Prevention of the Primary Cesarean Delivery. Obstet Gynecol 2014; 123 (03) 693-711
3 Blanchette H. The rising cesarean delivery rate in America: what are the consequences?. Obstet Gynecol 2011; 118 (03) 687-690
4 World Health Organization Human Reproduction Programme, 10 April 2015. WHO Statement on caesarean section rates. Reprod Health Matters 2015; 23 (45) 149-150
5 Barber EL, Lundsberg LS, Belanger K, Pettker CM, Funai EF, Illuzzi JL. Indications contributing to the increasing cesarean delivery rate. Obstet Gynecol 2011; 118 (01) 29-38
6 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
7 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
8 Friedman E. The graphic analysis of labor. Am J Obstet Gynecol 1954; 68 (06) 1568-1575
9 Martin JA, Hamilton BE, Osterman MJ, Driscoll AK, Mathews TJ. Births: final data for 2015. Natl Vital Stat Rep 2017; 66 (01) 1
10 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
11 Thuillier C, Roy S, Peyronet V, Quibel T, Nlandu A, Rozenberg P. Impact of recommended changes in labor management for prevention of the primary cesarean delivery. Am J Obstet Gynecol 2018; 218 (03) 341.e1-341.e9
12 Rosenbloom JI, Stout MJ, Tuuli MG. , et al. New labor management guidelines and changes in cesarean delivery patterns. Am J Obstet Gynecol 2017; 217 (06) 689.e1-689.e8
13 Spetz J, Smith MW, Ennis SF. Physician incentives and the timing of cesarean sections: evidence from California. Med Care 2001; 39 (06) 536-550
14 Metz TD, Allshouse AA, Gilbert SAB, Doyle R, Tong A, Carey JC. Variation in primary cesarean delivery rates by individual physician within a single-hospital laborist model. Am J Obstet Gynecol 2016; 214 (04) 531.e1-531.e6
15 Srinivas SK, Small DS, Macheras M, Hsu JY, Caldwell D, Lorch S. Evaluating the impact of the laborist model of obstetric care on maternal and neonatal outcomes. Am J Obstet Gynecol 2016; 215 (06) 770.e1-770.e9
16 Allen AJ, Caughey AB. The evolution of the laborist. Obstet Gynecol Clin North Am 2017; 44 (04) 625-629
17 Cohen WR, Friedman EA. Misguided guidelines for managing labor. Am J Obstet Gynecol 2015; 212 (06) 753.e1-753.e3
18 Bernitz S, Dalbye R, Øian P, Zhang J, Eggebø TM, Blix E. Study protocol: the Labor Progression Study, LAPS - does the use of a dynamic progression guideline in labor reduce the rate of intrapartum cesarean sections in nulliparous women? A multicenter, cluster randomized trial in Norway. BMC Pregnancy Childbirth 2017; 17 (01) 370
19 Caughey AB. The Cesarean epidemic: are we too quick to cut? Contemporary OB/GYN 2016 . Available at: http://www.contemporaryobgyn.net/modern-medicine-feature-articles/cesarean-epidemic-are-we-too-quick-cut . Accessed September 27, 2018
20 Gimovsky AC, Berghella V. Randomized controlled trial of prolonged second stage: extending the time limit vs usual guidelines. Am J Obstet Gynecol 2016; 214 (03) 361.e1-361.e6