Professional Documents
Culture Documents
Prevention
of the
Primary
Melinda Weiss, DO PGY3
April 1, 2016
Objectives
Describe the trend of cesarean section (CS) in
labor descriptions
Describe the recommended interventions to
decrease CS
Background
1996-2011: rapid increase in CS rate
2011: 1/3 women delivered via CS
No evidence of concomitant decrease in
rupture
For low risk pregnancies, CS has greater risk of
by route of delivery
hemorrhage requiring
uterine rupture
VTE
Placental abnormalities
NICU admission
Perinatal death
CS Rates
Variation across:
States: 23-40%
Hospitals: 7.1-69.9%
Labor dystocia
NRFHT
Malpresentation
Multiple gestation
Suspected macrosomia
*2011 data
Labor dystocia
NRFHT
>50%
Malpresentation
Multiple gestation
Suspected macrosomia
*2011 data
Nullip: 1.2cm/hr
Multip: 1.5cm/hr
Nullip: 0.5-0.7cm/hr
Multip: 0.5-1.3cm/hr
Abnormal labor?
Prolonged latent phase
Nope.
Induction
3 studies have shown IOL patients in latent labor 12-18 hours with
pitocin and ROM will deliver vaginally if induction is continued
2008)
Comparing IOL to spontaneous labor IOL
WRONG
neonatal sepsis
longer duration of active pushing NOT not associated with adverse neonatal
outcomes (even in >3hours pushing)
decreases
Forceps
Conflicting data?
NRFHT interventions
Other causes
Malpresentation (Breech) : 3.7% of pregnancies, 85% of
References