Date of Award
1-1-2018
Document Type
Open Access Thesis
Degree Name
Medical Doctor (MD)
Department
Medicine
First Advisor
Jessica Illuzzi
Abstract
Cesarean delivery for labor arrest currently makes up the largest proportion of
primary cesarean delivery in the United States. Because cesarean delivery is associated
with significant morbidity, it is important to limit its use to ensure the benefits outweigh
the risks. New diagnostic criteria to limit the diagnosis of labor arrest have the potential
to decrease the cesarean delivery rate. To investigate how cesarean delivery for arrest of
dilation or descent and failed induction contributed to the primary cesarean delivery rate,
we analyzed rates of primary cesarean for these indications among 17,864 live births at
our institution from 2010 through 2013. We used multiple logistic regression modeling to
identify predictors of meeting diagnostic criteria for these indications based on guidelines
published in 2012 by Spong et al. From 2010 through 2013 the total primary cesarean
delivery rate decreased from 23.5% to 21.1%. Over the same period, primary cesarean
delivery due specifically to arrest of dilation or descent and failed induction decreased
from 8.5% to 6.7%. Primary cesarean delivery due to arrest of dilation alone decreased
from 5.1% to 3.4%. The rate of meeting minimum criteria for arrest of dilation increased
from 18.8% to 34.9%. Primary cesarean delivery due to arrest of descent alone remained
relatively stable, however, the percent of cases meeting minimum criteria increased from
57.8% to 71.0%. The rate of primary cesarean delivery due to failed induction alone also
remained relatively stable, as did the percent of cases meeting minimum criteria with
50.00% meeting criteria in 2013. Attending type was a significant predictor of meetingiii
criteria for all three indications. Hospitalist cases were two to seven times as likely to
meet criteria compared with private cases. Dilation on admission increased, as well as the
likelihood of meeting criteria for arrest of dilation and arrest of descent. Epidural use
decreased the likelihood of meeting criteria for arrest of descent. In summary, the
decrease in primary cesarean delivery from 2010 through 2013 is significantly
attributable to a decrease in the diagnosis of labor arrest disorders and failed induction,
and specifically to a decrease in diagnosis of arrest of dilation. An increased likelihood of
meeting minimum criteria for arrest of dilation in 2012 and 2013 compared to 2010
suggests that applying new definitions of labor arrest published in 2012 can decrease the
overall primary cesarean rate. As of 2013, only 34.9% of primary cesareans performed
for arrest of dilation, 71.0% for arrest of descent, and 50.0% for failed induction, met new
respective minimum diagnostic criteria. This suggests that an even bigger decrease in the
primary cesarean rate can be achieved if a greater effort is made to meet minimum
criteria before moving to cesarean.
Recommended Citation
Greenberg, Jessica Tanzer Wright, "Implementation Of New Definitions Of Labor Arrest Disorders And Failed Induction Can Decrease The Cesarean Rate" (2018). Yale Medicine Thesis Digital Library. 3401.
https://elischolar.library.yale.edu/ymtdl/3401
