Cesarean For Dystocia Research Articles

Evaluating Fundal Dominant Contractions on Spatiotemporal Electrohysterography as a Marker for Effective Labor Contractions.

To evaluate if fundal (F) dominance of the electrohysterogram is associated with vaginal delivery and lack of F dominance is associated with cesarean for labor dystocia. We conducted a prospective cohort study of nulliparous women in spontaneous labor at ≥36 weeks. Clinicians were blinded to electrohysterography data which were in addition to standard cardiotocography. All contractions in the hour preceding diagnosis of complete cervical dilation (for women delivering vaginally) or the hour preceding the decision for cesarean were analyzed. Of 224 patients, 167 had evaluable data. The proportion of F dominant contractions was not different for women undergoing cesarean for labor dystocia (n = 11) compared with all others (n = 156)-88.7 ± 10.2 versus 86.0 ± 11.4%; p = 0.44. Results were similar when comparing the cesarean for labor dystocia group to those undergoing cesarean for other indications (n = 10) and vaginal deliveries (n = 146)-88.7 ± 10.2 versus 86.5 ± 10.0 versus 85.9 ± 11.5%; p = 0.74. We were unable to confirm our earlier finding that F dominance of the electrohysterogram is associated with vaginal delivery and lack of F dominance is associated with cesarean for dystocia.

Ultrasound examination at term for predicting the outcome of delivery in women with a previous cesarean section

Objective: To evaluate if ultrasound variables at term are associated with the mode of delivery in women with previous cesarean section (PCS).Methods: This was a prospective study of singleton pregnant women who planned a trial of vaginal birth after cesarean delivery. Cervical length, posterior cervical angle, head–perineum distance, and estimated fetal weight were measured at 37–39 weeks of gestation.Results: One hundred forty-four pregnancies were examined and vaginal delivery was achieved in 98 women (73%). Logistic regression analysis identified cervical length, head–perineum distance, age, previous vaginal delivery, previous cesarean for dystocia, and Bishop score as predictors of vaginal delivery. Combining ultrasound and clinical parameters, two models for risk scoring that differ in the variable Bishop score or cervical length were constructed. The AUC of these models was 0.867 and 0.855, respectively.Conclusions: In women with a PCS, measurement of cervical length and head–perineum distance at term is associated with the mode of delivery. A combination of clinical and sonographic parameters at term can predict the likelihood of vaginal delivery.

309: Uterine rupture in women with previous cesarean for dystocia in second stage of labor

for dystocia in second stage of labor Nicole Jastrow, Suzanne Demers, Robert J. Gauthier, Nils Chaillet, Normand Brassard, Emmanuel Bujold University Hospital of Geneva, Obstetrics and Gynecology, Geneva, Switzerland, University Laval, Obstetrics and Gynecology, Quebec, QC, Canada, University of Montreal, Obstetrics and Gynecology, Montreal, QC, Canada OBJECTIVE: To evaluate the risk of uterine rupture in women undergoing a trial of labor (TOL) after a previous cesarean for dystocia in second stage of labor. STUDY DESIGN: A retrospective cohort study of women with a single previous low-transverse cesarean undergoing a first TOL was performed. Women with a previous cesarean for dystocia in second stage were compared to those with previous dystocia in first stage and those with previous cesarean for non-recurrent reasons. Chi-square and Fishers exact were used when appropriate. RESULTS: Out of 1950 women, those with previous dystocia in second stage of labor (n 220) had a similar risk of uterine rupture than women with previous dystocia in the first stage (n 639) and women with previous cesarean for non-recurrent indication (1.8%, 1.7%, and 1.5%, respectively, p 0.88). However, we found that all (100%) uterine ruptures in the former group occurred in the second stage of labor (p 0.05) compared to 18% and 25% in the two other groups (p 0.05). The median length of the second stage of labor before uterine rupture was 2.5 hours (interquartile: 1.5 3.2 hours) for those cases. CONCLUSION: Previous cesarean for dystocia in the second stage of labor is associated with uterine rupture in the second stage of the subsequent delivery. This may be related to a lower location of the uterine scar, which may be more prone to rupture at an advanced cervical dilatation during the next delivery. Prolonged second stage should be avoided in these women.

The MFMU Cesarean Registry: Impact of Fetal Size on Trial of Labor Success for Patients with Previous Cesarean for Dystocia

The MFMU Cesarean Registry: Impact of Fetal Size on Trial of Labor Success for Patients with Previous Cesarean for Dystocia

The MFMU cesarean registry: Impact of infant birth weight on subsequent trial of labor for patients with prior cesarean for dystocia

The MFMU cesarean registry: Impact of infant birth weight on subsequent trial of labor for patients with prior cesarean for dystocia

Dystocia in nulliparous patients monitored with fetal pulse oximetry

Objective A critical analysis of the United States randomized controlled trial of fetal pulse oximetry concluded that nonreassuring fetal heart rate patterns used for study entry may have been a marker for dystocia. We prospectively studied nulliparous women in labor whose progress was monitored with fetal pulse oximetry to examine the relationship between nonreassuring fetal heart rate patterns and operative delivery for dystocia. Study design A prospective nonrandomized observational cohort study compared two distinct classes of nonreassuring fetal heart rate patterns (class I: intermittent, mildly nonreassuring; class II: persistent, progressive, and moderate to severely nonreassuring) among nulliparous patients with the use of fetal pulse oximetry to confirm fetal well-being. Definitions of dystocia included the cessation of labor progress in the first (3 hours) or second (2 hours) stage of labor, despite adequate uterine activity that was assessed with an intrauterine pressure catheter. Independent review confirmed the classification of nonreassuring fetal heart rate patterns and study entry criteria. Results Two hundred seventy-four patients met study criteria and had sufficient information for fetal heart rate tracing interpretation. Two hundred thirty-seven patients (86.5%) were class II, and 37 patients (13.5%) were class I. The two classes of patients were comparable in a variety of obstetric, demographic, and perinatal variables. Twelve percent of all patients were delivered for nonreassuring fetal status. Significantly more class II patients (22%) were delivered by cesarean for dystocia than were class I patients (8%). Higher doses and a longer number of hours of oxytocin were required among class II patients. Significantly more occiput posterior positions were noted among all patients who underwent cesarean delivery for dystocia compared with other modes of delivery. Conclusion Significantly nonreassuring fetal heart rate patterns predict cesarean delivery for dystocia among nulliparous patients with normally oxygenated fetuses in a setting of a standardized labor management protocol. This confirms the observations in the randomized controlled trial of fetal pulse oximetry in the United States and may provide insight into the treatment of nonprogressive labor in contemporary practice.

Is a trial of labor indicated after a prior cesarean delivery for dystocia when the estimated fetal weight is greater than the prior newborn's weight?

DELIVERY FOR DYSTOCIA WHEN THE ESTIMATED FETAL WEIGHT IS GREATER THAN THE PRIOR NEWBORN’S WEIGHT? EMMANUEL BUJOLD, ISRAEL HENDLER, SUSAN BERMAN, SEAN BLACKWELL, ROBERT GAUTHIER, Wayne State University, Obstetrics and Gynecology, Detroit, MI Sainte-Justine Hospital, Obstetrics & Gynecology, Montreal, Quebec, Canada OBJECTIVE: To estimate if the rates of failed TOL and uterine rupture in patients with a prior cesarean delivery for dystocia are increased if the neonatal birth weight is higher than the one at the prior cesarean. STUDY DESIGN: Charts of all patients at term who had a trial of labor after a prior cesarean for dystocia in our institution between 1988 and 2002 were reviewed. The rates of successful VBAC, uterine rupture, and adverse obstetrical outcomes were associated with birth weight at the time of the prior cesarean, birth weight at the time of TOL, and the difference between the two. To adjust for confounding variables, univariate and multivariate regression analysis were performed . RESULTS: Out of 1015 patients with a prior cesarean for dystocia, 191 (19%) had a prior baby over 4000 g, 138 (14%) had a neonate with an actual birth weight over 4000 g, and 470 (46%) had a neonate with an actual birth weight greater than the birth weight of the prior newborn. In a univariate analysis, a neonate > 4000 g at the time of TOL (51% vs 69%, P 4000 g at the time of TOL was associated with a failed TOL (see Table). None of those three factors related to neonatal birth weight were associated with a higher risk of uterine rupture. CONCLUSION: Contrary to popular belief, the prior neonatal birth weight is not related to obstetrical outcomes in patients with a prior history of cesarean for dystocia.

Should we allow a trial of labor after a previous cesarean for dystocia in the second stage of labor?

Should we allow a trial of labor after a previous cesarean for dystocia in the second stage of labor?