Applying a physiologic partograph to Consortium on Safe Labor data to identify opportunities for safely decreasing cesarean births among nulliparous women

Jeremy L. Neal, Nancy K. Lowe, Aaron Caughey, Kelly A. Bennett, Ellen Tilden, Nicole S. Carlson, Julia C. Phillippi, Mary S. Dietrich

Research output: Contribution to journalArticle

Abstract

Background: The timing of hospital admission for women with spontaneous labor onset and the criteria used to assess active labor progress and diagnose labor dystocia may significantly influence women's risk for primary cesarean birth. Our aims were to assess associations of labor status at admission (i.e., preactive or active) and active labor progress (i.e., dystocic or physiologic) with oxytocin augmentation, cesarean birth, and adverse neonatal outcome rates. Methods: A sample of low-risk, nulliparous women admitted to hospitals for spontaneous labor onset was extracted from the Consortium on Safe Labor (n = 27 077). Binomial logistic regression was used to assess associations between labor classifications and outcomes. Results: At admission, 68.0% of women were in preactive labor and 32.0% were in active labor. Cesarean rates for these groups were 18.0% and 7.2%, respectively (adjusted odds ratio [AOR] 2.69; 95% CI 2.45-2.96). Oxytocin augmentation and adverse neonatal outcomes were more likely for women admitted in preactive labor. Among women admitted in active labor, 9.3% experienced labor dystocia and 90.7% progressed physiologically. Cesarean rates for these groups were 20.4% and 5.9%, respectively (AOR 3.02; 95% CI 2.45-3.73). Nearly half of the cesareans performed for dystocia among women admitted in active labor occurred when cervical dilation was physiologic. Oxytocin augmentation and adverse neonatal outcomes were more likely when active labor was dystocic. Conclusions: Adoption of evidence-based, standardized approaches for diagnosing active labor onset, assessing labor progress, and diagnosing dystocia may safely decrease oxytocin augmentation and cesarean birth rates in the United States.

Original languageEnglish (US)
JournalBirth
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Dystocia
Parturition
Oxytocin
Labor Onset
Odds Ratio
Birth Rate
Dilatation
Logistic Models

Keywords

  • Cesarean section
  • Labor onset
  • Nulliparity
  • Oxytocin
  • Parturition
  • Term birth

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Applying a physiologic partograph to Consortium on Safe Labor data to identify opportunities for safely decreasing cesarean births among nulliparous women. / Neal, Jeremy L.; Lowe, Nancy K.; Caughey, Aaron; Bennett, Kelly A.; Tilden, Ellen; Carlson, Nicole S.; Phillippi, Julia C.; Dietrich, Mary S.

In: Birth, 01.01.2018.

Research output: Contribution to journalArticle

Neal, Jeremy L. ; Lowe, Nancy K. ; Caughey, Aaron ; Bennett, Kelly A. ; Tilden, Ellen ; Carlson, Nicole S. ; Phillippi, Julia C. ; Dietrich, Mary S. / Applying a physiologic partograph to Consortium on Safe Labor data to identify opportunities for safely decreasing cesarean births among nulliparous women. In: Birth. 2018.
@article{d818481aa296458ea0c8b94af547ef4f,
title = "Applying a physiologic partograph to Consortium on Safe Labor data to identify opportunities for safely decreasing cesarean births among nulliparous women",
abstract = "Background: The timing of hospital admission for women with spontaneous labor onset and the criteria used to assess active labor progress and diagnose labor dystocia may significantly influence women's risk for primary cesarean birth. Our aims were to assess associations of labor status at admission (i.e., preactive or active) and active labor progress (i.e., dystocic or physiologic) with oxytocin augmentation, cesarean birth, and adverse neonatal outcome rates. Methods: A sample of low-risk, nulliparous women admitted to hospitals for spontaneous labor onset was extracted from the Consortium on Safe Labor (n = 27 077). Binomial logistic regression was used to assess associations between labor classifications and outcomes. Results: At admission, 68.0{\%} of women were in preactive labor and 32.0{\%} were in active labor. Cesarean rates for these groups were 18.0{\%} and 7.2{\%}, respectively (adjusted odds ratio [AOR] 2.69; 95{\%} CI 2.45-2.96). Oxytocin augmentation and adverse neonatal outcomes were more likely for women admitted in preactive labor. Among women admitted in active labor, 9.3{\%} experienced labor dystocia and 90.7{\%} progressed physiologically. Cesarean rates for these groups were 20.4{\%} and 5.9{\%}, respectively (AOR 3.02; 95{\%} CI 2.45-3.73). Nearly half of the cesareans performed for dystocia among women admitted in active labor occurred when cervical dilation was physiologic. Oxytocin augmentation and adverse neonatal outcomes were more likely when active labor was dystocic. Conclusions: Adoption of evidence-based, standardized approaches for diagnosing active labor onset, assessing labor progress, and diagnosing dystocia may safely decrease oxytocin augmentation and cesarean birth rates in the United States.",
keywords = "Cesarean section, Labor onset, Nulliparity, Oxytocin, Parturition, Term birth",
author = "Neal, {Jeremy L.} and Lowe, {Nancy K.} and Aaron Caughey and Bennett, {Kelly A.} and Ellen Tilden and Carlson, {Nicole S.} and Phillippi, {Julia C.} and Dietrich, {Mary S.}",
year = "2018",
month = "1",
day = "1",
doi = "10.1111/birt.12358",
language = "English (US)",
journal = "Birth",
issn = "0730-7659",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Applying a physiologic partograph to Consortium on Safe Labor data to identify opportunities for safely decreasing cesarean births among nulliparous women

AU - Neal, Jeremy L.

AU - Lowe, Nancy K.

AU - Caughey, Aaron

AU - Bennett, Kelly A.

AU - Tilden, Ellen

AU - Carlson, Nicole S.

AU - Phillippi, Julia C.

AU - Dietrich, Mary S.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: The timing of hospital admission for women with spontaneous labor onset and the criteria used to assess active labor progress and diagnose labor dystocia may significantly influence women's risk for primary cesarean birth. Our aims were to assess associations of labor status at admission (i.e., preactive or active) and active labor progress (i.e., dystocic or physiologic) with oxytocin augmentation, cesarean birth, and adverse neonatal outcome rates. Methods: A sample of low-risk, nulliparous women admitted to hospitals for spontaneous labor onset was extracted from the Consortium on Safe Labor (n = 27 077). Binomial logistic regression was used to assess associations between labor classifications and outcomes. Results: At admission, 68.0% of women were in preactive labor and 32.0% were in active labor. Cesarean rates for these groups were 18.0% and 7.2%, respectively (adjusted odds ratio [AOR] 2.69; 95% CI 2.45-2.96). Oxytocin augmentation and adverse neonatal outcomes were more likely for women admitted in preactive labor. Among women admitted in active labor, 9.3% experienced labor dystocia and 90.7% progressed physiologically. Cesarean rates for these groups were 20.4% and 5.9%, respectively (AOR 3.02; 95% CI 2.45-3.73). Nearly half of the cesareans performed for dystocia among women admitted in active labor occurred when cervical dilation was physiologic. Oxytocin augmentation and adverse neonatal outcomes were more likely when active labor was dystocic. Conclusions: Adoption of evidence-based, standardized approaches for diagnosing active labor onset, assessing labor progress, and diagnosing dystocia may safely decrease oxytocin augmentation and cesarean birth rates in the United States.

AB - Background: The timing of hospital admission for women with spontaneous labor onset and the criteria used to assess active labor progress and diagnose labor dystocia may significantly influence women's risk for primary cesarean birth. Our aims were to assess associations of labor status at admission (i.e., preactive or active) and active labor progress (i.e., dystocic or physiologic) with oxytocin augmentation, cesarean birth, and adverse neonatal outcome rates. Methods: A sample of low-risk, nulliparous women admitted to hospitals for spontaneous labor onset was extracted from the Consortium on Safe Labor (n = 27 077). Binomial logistic regression was used to assess associations between labor classifications and outcomes. Results: At admission, 68.0% of women were in preactive labor and 32.0% were in active labor. Cesarean rates for these groups were 18.0% and 7.2%, respectively (adjusted odds ratio [AOR] 2.69; 95% CI 2.45-2.96). Oxytocin augmentation and adverse neonatal outcomes were more likely for women admitted in preactive labor. Among women admitted in active labor, 9.3% experienced labor dystocia and 90.7% progressed physiologically. Cesarean rates for these groups were 20.4% and 5.9%, respectively (AOR 3.02; 95% CI 2.45-3.73). Nearly half of the cesareans performed for dystocia among women admitted in active labor occurred when cervical dilation was physiologic. Oxytocin augmentation and adverse neonatal outcomes were more likely when active labor was dystocic. Conclusions: Adoption of evidence-based, standardized approaches for diagnosing active labor onset, assessing labor progress, and diagnosing dystocia may safely decrease oxytocin augmentation and cesarean birth rates in the United States.

KW - Cesarean section

KW - Labor onset

KW - Nulliparity

KW - Oxytocin

KW - Parturition

KW - Term birth

UR - http://www.scopus.com/inward/record.url?scp=85047786458&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85047786458&partnerID=8YFLogxK

U2 - 10.1111/birt.12358

DO - 10.1111/birt.12358

M3 - Article

JO - Birth

JF - Birth

SN - 0730-7659

ER -