Peripartum Morbidity after Cesarean Delivery for Arrest of Dilation at 4 to 5 cm Compared with 6 to 10 cm

Joshua D. Dahlke; Jeffrey D. Sperling; Phinnara Has; Todd R. Lovgren; Brendan D. Connealy; Dwight J. Rouse

doi:10.1055/s-0038-1642063

American Journal of Perinatology, Table of Contents

Am J Perinatol 2018; 35(12): 1173-1177
DOI: 10.1055/s-0038-1642063

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Peripartum Morbidity after Cesarean Delivery for Arrest of Dilation at 4 to 5 cm Compared with 6 to 10 cm

Joshua D. Dahlke

¹Division of Maternal-Fetal Medicine, Methodisth Women's Hospital and Perinatal Center, Omaha, Nebraska

,

Jeffrey D. Sperling

²Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California

,

Phinnara Has

³Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Women and Infants Hospital of Rhode Island, The Warren Alpert Medical School of Brown University, Providence, Rhode Island

,

Todd R. Lovgren

¹Division of Maternal-Fetal Medicine, Methodisth Women's Hospital and Perinatal Center, Omaha, Nebraska

,

Brendan D. Connealy

¹Division of Maternal-Fetal Medicine, Methodisth Women's Hospital and Perinatal Center, Omaha, Nebraska

,

Dwight J. Rouse

³Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Women and Infants Hospital of Rhode Island, The Warren Alpert Medical School of Brown University, Providence, Rhode Island

› Author Affiliations

Abstract

Objective Given that recent consensus guidelines established to decrease cesarean delivery (CD) rates use 6 cm to define the onset of the active phase of labor, our objective was to evaluate maternal and neonatal outcomes after CD for the indication of arrest of dilation at 4 to 5 cm compared with ≥ 6 cm.

Study Design We performed a secondary analysis using data from the Maternal Fetal-Medicine Units Network Cesarean Registry. We included nulliparous women with term, singleton, vertex gestations who underwent primary CD for arrest of dilation. We compared those who reached a maximum cervical dilation of 4 to 5 cm with those of ≥6 cm. Our primary outcome was composite maternal morbidity that included chorioamnionitis, endometritis, transfusion, wound complication, operative injury, intensive care unit admission, or death.

Results Of the 73,257 women in the dataset, 5,681 met the inclusion criteria. After adjusting for confounders, there was no difference in composite maternal (adjusted odds ratio [aOR]: 1.19; 95% confidence interval [CI]: 0.94–1.52) or neonatal morbidity (aOR: 0.94; 95% CI: 0.79–1.10) between the groups.

Conclusion In this historical cohort, maternal and neonatal outcomes after CD for arrest of dilation ≥ 6 cm were comparable to those performed at 4 to 5 cm and support recent labor management guidelines.

Keywords

cesarean - arrest of dilation - maternal morbidity - neonatal morbidity

Full Text

References

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