Compliance With Contemporary Criteria for the Diagnosis of Labor Dystocia by Time of Day [23O

Abstract

INTRODUCTION: To evaluate the relationship between time of day and compliance with contemporary criteria for the diagnosis of labor dystocia. METHODS: This was a secondary analysis of a prospective cohort study of cesarean delivery rates following implementation of a labor dystocia checklist at a community hospital. The checklist requested that physicians specify which of the contemporary criteria for the diagnosis of labor dystocia were met prior to performing a cesarean delivery on women in labor. Following implementation, the primary and NTSV cesarean delivery rates decreased from 20.7% to 18.0% and 26.4% to 22.6%, respectively. Data were then reviewed and categorized as either compliant or noncompliant with contemporary criteria and rates of compliance compared between three time periods: daytime (8AM-6PM), evening (6PM-12AM), and overnight (12AM-8AM). RESULTS: Of 145 Cesarean sections performed for dystocia, 52 (35.8%) occurred between 8AM-6PM, 49 (33.8%) occurred between 6PM-12AM, and 44 (30.3%) occurred between 12AM-8AM. Overall, 64 (44.1%) were compliant with contemporary guidelines for the diagnosis of labor dystocia. Compared to the evening and overnight time periods, cesarean deliveries performed for labor dystocia during the daytime were more likely to be compliant with contemporary criteria for the diagnosis of labor dystocia. (P = 0.02). CONCLUSION: Cesarean deliveries performed for labor dystocia during the daytime are more likely to satisfy contemporary criteria for the diagnosis of labor dystocia than those performed during the evening or overnight. Additional studies are needed to further evaluate the impact that time of day may have on physicians' decision-making process when diagnosing labor dystocia.