Preventing the Primary Cesarean Delivery—Adherence to Labor Arrest Guidelines [28P

Abstract

INTRODUCTION: The ACOG/SMFM Safe Prevention of Primary Cesarean Delivery guidelines suggest minimum criteria at which cesarean should be performed for labor arrest with the goal of reducing primary cesarean delivery rates. This study evaluates current adherence to these criteria at an academic medical center with two different campuses in order to quantify variation in the modifiable proportion of the cesarean rate and to target quality improvement initiatives. METHODS: We analyzed cesareans deliveries performed for arrest of dilation, arrest of descent and failed induction among singleton, term, cephalic live births at a large academic center with two campuses from September 2018 to August 2019. Using the ACOG/SMFM guidelines, the labor course for each cesarean was examined to determine if minimum criteria were met. RESULTS: During the study period, there were 1716 cesarean deliveries with 286 performed for labor arrest disorders: 94 for arrest of dilation, 120 for arrest of descent, and 72 for failed induction of labor. At campus A, 27% met criteria for arrest of dilation, 46% for arrest of descent, and 45% for failed induction; at campus B, 95% met criteria for arrest of dilation, 61% for arrest of descent, and 60% for failed induction. Over the study period, the primary cesarean rates at campus A and B were 19.4% and 13.4%, respectively. CONCLUSION: The adherence to criteria for arrest disorders was suboptimal and varied significantly across campuses. Quality improvement initiatives targeted to improve adherence to criteria for labor arrest disorders have the potential to impact primary cesarean delivery rates.