Implementation of Pre-cesarean Checklist for Labor Arrest and Failed Induction [16P

Abstract

INTRODUCTION: National and Stamford Hospital cesarean delivery (CD) rates, at 32% and 40.4% respectively, remain high. A large contributor to the primary CD rate is labor arrest, including failed induction of labor (IOL). Use of new guidelines for diagnosing these conditions have been shown to decrease the CD rate. This study aims to assess adherence to new definitions and the impact of a pre-cesarean checklist at our institution. METHODS: A retrospective chart review for primary CD in nulliparous, singleton, term, vertex (NSTV) pregnancies performed for labor arrest, including failed IOL, from January 2018 to August 2019. In January 2019 a paper pre-cesarean checklist, adapted from a previously published checklist was introduced to labor and delivery to allow physicians to review labor arrest criteria. Calculated primary CD rates for labor arrest pre and post implementation were compared using chi square analysis. RESULTS: The primary cesarean delivery (pCD) rate in NSTV pregnancies for labor arrest was 14.1% in 2018 and 12.5% in 2019 (P=.5). Of the 55 pCD for labor arrest in 2019, 17 (30.9%) filled out the pre-cesarean checklist. Only 18 (32.79%) met criteria for labor arrest/failed IOL. CONCLUSION: At our institution, CD in NSTV pregnancies for labor arrest or failed IOL do not meet contemporary definitions. Introduction of a paper pre-cesarean checklist to evaluate labor arrest has not affected the CD rate. However, use of the checklist was limited, thus there remains significant room for a decrease in the cesarean rate if adherence can be improved.