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Archives of Gynecology and Obstetrics
Published in: Archives of Gynecology and Obstetrics 4/2016

01-10-2016 | Maternal-Fetal Medicine

Prevention of primary caesarean delivery: comprehensive management of dystocia in nulliparous patients at term

Authors: Antonio Ragusa, Salvatore Gizzo, Marco Noventa, Enrico Ferrazzi, Sara Deiana, Alessandro Svelato

Published in: Archives of Gynecology and Obstetrics | Issue 4/2016

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Abstract

Purpose

Dystocia is the leading indication for primary caesarean sections. Our aim is to compare two approaches in the management of dystocia in labor in nulliparous women with a singleton fetus in cephalic presentation at term in spontaneous or induced labor.

Methods

Prospective cohort study. Four hundred and nineteen consecutive patients were divided into two groups: the standard management group (SM), in acceleration of labor was commenced at the “action line” in the case of arrested or protracted labor, and the comprehensive management group (CM) in which arrested or protracted labor was considered as a warning sign promoting further diagnostic assessment prior to considering intervention.

Results

Caesarean sections rate was 22.2 % in the SM group (216 patients) and 10.3 % in the CM group (203 patients) (p = 0.001). The rate of oxytocin use decreased from 33.3 % in SM group to 13.8 % in the CM group (p < 0.0005). The rate of amniotomy decreased from 41.7 % in the SM group to 7.4 % in the CM group (p < 0.0005). The percentage of newborns with 5-min Apgar score <7 and/or umbilical cord arterial pH ≤ 7.00 decreased from 2.3 % in SM cohort to 0.5 % in CM cohort (p = ns). The average length of labor did not differ between the two groups of patients (264 vs 277 min; p = ns).

Conclusion

Comprehensive management of dystocia enabled us to achieve a reduction in iatrogenic interventions in labor while maintaining good neonatal outcomes.
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Metadata
Title
Prevention of primary caesarean delivery: comprehensive management of dystocia in nulliparous patients at term
Authors
Antonio Ragusa
Salvatore Gizzo
Marco Noventa
Enrico Ferrazzi
Sara Deiana
Alessandro Svelato
Publication date
01-10-2016
Publisher
Springer Berlin Heidelberg
Published in
Archives of Gynecology and Obstetrics / Issue 4/2016
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI
https://doi.org/10.1007/s00404-016-4046-5

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