352: Laboring beyond the obstetric care consensus (OCC) labor dystocia guidelines: Proceed with caution

Abstract

To evaluate whether or not allowing women to labor beyond the OCC labor dystocia guidelines is associated with increased maternal and neonatal complications. This is a retrospective chart review performed on 640 nulliparous, term, singleton, vertex (NTSV) patients delivering between January 2013 and May 2017 at an academic community hospital managed by the residents’ service. Forty-eight were identified with protracted active labor: ≥ 6cm and protracted at least 6 hours without change in dilation (beyond the OCC guidelines). We then compared the prospect of vaginal delivery and maternal and neonatal complications in this group with two others: those who had protracted labor within the OCC guidelines (4-6 hours in the active phase without cervical change) (N=47) as well as those that did not experience protracted labor (N=371). Women that labored beyond the OCC guidelines had a 42.5% vaginal delivery rate (mean duration of total protraction 9.1 +/- 2.1 hours). However, they also had a statistically significant higher rate of cesarean delivery (P<.001), quantified blood loss (QBL) (P=.01), and NICU admission rates (P<.001) compared to those laboring within the OCC guidelines. We also noted an increase in suspected intrauterine infection or inflammation (triple I) (P=.008), need for maternal blood transfusion (P=.01) and maternal length of stay (LOS) (P<.001) between those with protracted labor >6h and non-protracted labor. Rates of neonatal sepsis and 5-minute Apgar <7 were not statistically significant between the groups. There were no maternal ICU admissions, cesarean hysterectomies, or maternal/neonatal deaths. Women who labored beyond the OCC labor dystocia guidelines can still achieve vaginal delivery, but with increased select maternal and newborn risks. Still, there were no serious complications in either group. Proceeding with labor beyond the OCC guideline may be considered, but with caution.