Compliance With Contemporary Guidelines for the Diagnosis of Labor Dystocia by Stage of Labor [22O

Abstract

INTRODUCTION: The objective of this study was to evaluate the relationship between stage of labor 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. In this analysis, primary cesarean deliveries performed for labor dystocia were reviewed and categorized based on furthest stage of labor achieved and whether contemporary criteria for labor dystocia were fulfilled. Rates of compliance were compared between each stage of labor. RESULTS: During the 6-month study period, 145 cesarean deliveries were performed for labor dystocia. A majority (55.9%) were not compliant with contemporary guidelines for the diagnosis of labor dystocia. A greater proportion of deliveries that occurred in the latent phase (63.6%) and second stage (58.3%) were compliant compared to those that were failed inductions (33.3%) or that occurred in the active phase (38.2%), however, this difference was not statistically significant (P = 0.07). CONCLUSION: Most cesarean deliveries performed for labor dystocia did not meet contemporary criteria for the diagnosis of labor dystocia. Interventions designed to increase provider awareness of recent Obstetric Care Consensus guidelines for labor dystocia are needed for all stages of labor.