Implementation Of New Definitions Of Labor Arrest Disorders And Failed Induction Can Decrease The Cesarean Rate

Cesarean delivery for labor arrest currently makes up the largest proportion of primary cesarean delivery in the United States. Because cesarean delivery is associated with significant morbidity, it is important to limit its use to ensure the benefits outweigh the risks. New diagnostic criteria to limit the diagnosis of labor arrest have the potential to decrease the cesarean delivery rate. To investigate how cesarean delivery for arrest of dilation or descent and failed induction contributed to the primary cesarean delivery rate, we analyzed rates of primary cesarean for these indications among 17,864 live births at our institution from 2010 through 2013. We used multiple logistic regression modeling to identify predictors of meeting diagnostic criteria for these indications based on guidelines published in 2012 by Spong et al. From 2010 through 2013 the total primary cesarean delivery rate decreased from 23.5% to 21.1%. Over the same period, primary cesarean delivery due specifically to arrest of dilation or descent and failed induction decreased from 8.5% to 6.7%. Primary cesarean delivery due to arrest of dilation alone decreased from 5.1% to 3.4%. The rate of meeting minimum criteria for arrest of dilation increased from 18.8% to 34.9%. Primary cesarean delivery due to arrest of descent alone remained relatively stable, however, the percent of cases meeting minimum criteria increased from 57.8% to 71.0%. The rate of primary cesarean delivery due to failed induction alone also remained relatively stable, as did the percent of cases meeting minimum criteria with 50.00% meeting criteria in 2013. Attending type was a significant predictor of meetingiii criteria for all three indications. Hospitalist cases were two to seven times as likely to meet criteria compared with private cases. Dilation on admission increased, as well as the likelihood of meeting criteria for arrest of dilation and arrest of descent. Epidural use decreased the likelihood of meeting criteria for arrest of descent. In summary, the decrease in primary cesarean delivery from 2010 through 2013 is significantly attributable to a decrease in the diagnosis of labor arrest disorders and failed induction, and specifically to a decrease in diagnosis of arrest of dilation. An increased likelihood of meeting minimum criteria for arrest of dilation in 2012 and 2013 compared to 2010 suggests that applying new definitions of labor arrest published in 2012 can decrease the overall primary cesarean rate. As of 2013, only 34.9% of primary cesareans performed for arrest of dilation, 71.0% for arrest of descent, and 50.0% for failed induction, met new respective minimum diagnostic criteria. This suggests that an even bigger decrease in the primary cesarean rate can be achieved if a greater effort is made to meet minimum criteria before moving to cesarean