"One third of all first-time cesareans are performed due to active-phase arrest during labor, which contributes to approximately 400,000 surgical births per year," said Caughey, who is affiliated with the UCSF National Center of Excellence in Women's Health. "In our study, we found that just by being patient, one third of those women could have avoided the more dangerous and costly surgical approach."If you'd like a copy of the full text, email me. The abstract is below:
Henry, Dana E. M.; Cheng, Yvonne W.; Shaffer, Brian L.; Kaimal, Anjali J.; Bianco, Katherine; Caughey, Aaron B. "Perinatal Outcomes in the Setting of Active Phase Arrest of Labor." Obstetrics & Gynecology 112.5 (November 2008):1109-1115.
OBJECTIVE: To examine the association between active phase arrest and perinatal outcomes.
METHODS: This was a retrospective cohort study of women with term, singleton, cephalic gestations diagnosed with active phase arrest of labor, defined as no cervical change for 2 hours despite adequate uterine contractions. Women with active phase arrest who underwent a cesarean delivery were compared with those who delivered vaginally, and women who delivered vaginally with active phase arrest were compared with those without active phase arrest. The association between active phase arrest, mode of delivery, and perinatal outcomes was evaluated using univariable and multivariable logistic regression models.
RESULTS: We identified 1,014 women with active phase arrest: 33% (335) went on to deliver vaginally, and the rest had cesarean deliveries. Cesarean delivery was associated with an increased risk of chorioamnionitis (adjusted odds ratio [aOR] 3.37, 95% confidence interval [CI] 2.21-5.15), endomyometritis (aOR 48.41, 95% CI 6.61-354), postpartum hemorrhage (aOR 5.18, 95% CI 3.42-7.85), and severe postpartum hemorrhage (aOR 14.97, 95% CI 1.77-126). There were no differences in adverse neonatal outcomes. Among women who delivered vaginally, women with active phase arrest had significantly increased odds of chorioamnionitis (aOR 2.70, 95% CI 1.22-2.36) and shoulder dystocia (aOR 2.37, 95% CI 1.33-4.25). However, there were no differences in the serious sequelae associated with these outcomes, including neonatal sepsis or Erb's palsy.
CONCLUSION: Efforts to achieve vaginal delivery in the setting of active phase arrest may reduce the maternal risks associated with cesarean delivery without additional risk to the neonate.
LEVEL OF EVIDENCE: II
I'm not totally clear on how the vaginal delivery vs. cesarean groups were determined. Once they had a diagnosis of arrest, did the cesarean group all undergo surgery within two hours as your summary suggests?? Or did they as a group *eventually* have a cesarean at any later point? Those who had a cesarean say 5 hours later, how were they grouped? I suppose I could read the full text but that would require time, LOL! Where does the 'two hours' come from?
ReplyDeleteI am also rather ignorant about how this charting is actually done. Anyone? Is it the overall shape of the graph -- steep rise followed by a plateau?
I have always felt very grateful for medical staff who took a non-interventionist approach with my first labor, which lasted well over 24 hrs. Lily was born in a hospital with a c-section rate, if I remember correctly, at about 11%; exceptionally low in this country. I'm sure I plateaued at least once during the time I was there, but aside from intermittent monitoring they pretty much left me alone until I was ready to push--and 15 minutes later my beautiful daughter was born. I have only since learned what an unusual experience this was.
ReplyDeleteIt also seems as though they define FTP by cervical dilation only? Is that "correct?" AROM caused (in my opinion) my daughter to get stuck; she didn't descend; I stopped pushing after 2 hrs; had a cesarean a couple of hours later... I failed to progress and the diagnosis (such BS) was CPD.
ReplyDeleteAnyway, it doesn't surprise me that very few women are encouraged to wait out stalled labor. We certainly aren't encouraged to wait out stalled birth. "Oh honey, are you ready for your cesarean?"
I'd love the full-text and have emailed you, waiting for it with bated breath, but in the meantime...
ReplyDeleteIt seems that both groups had "increased risk" of chorioamniotitis? Increased compared to what? Not each other, if both had higher risk. Is it in comparison to women who had vaginal birth w/o active phase arrest?
-Kathy