1. Amy Bell Peter Cherouny Sue Gullo
Session Code L22
These presenters have nothing to disclose
L22 Full Circle:
Amy Bell
Peter Cherouny
Sue Gullo
December 7, :00pm-4:30pm Aruba/Bahama

2. Preventing the First Cesarean Delivery
The movement in national OB imperatives
Decreasing the hospital and provider variation
Minimizing misuse of our tools
Increasing where underused
Avoiding overuse
Clarifying definitions where required
Reliably delivering care
Spong CY et al. Preventing the First Cesarean Delivery: Summary of a Joint Eunice Kennedy Shriver
National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine,
and American College of Obstetricians and Gynecologists Workshop. Obstet Gynecol;120:1181

3. Preventing the First Cesarean Delivery
Clarifying definitions
Defining abnormal labor
Defining normal labor that is understood and accepted

4. Preventing the First Cesarean Delivery
Spong CY et al. Preventing the First Cesarean Delivery: Summary of a Joint Eunice Kennedy Shriver
National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine,
and American College of Obstetricians and Gynecologists Workshop. Obstet Gynecol;120:1181

5. Preventing the First Cesarean Delivery
Spong CY et al. Preventing the First Cesarean Delivery: Summary of a Joint Eunice Kennedy Shriver
National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine,
and American College of Obstetricians and Gynecologists Workshop. Obstet Gynecol;120:1181

6. Preventing the First Cesarean Delivery
Zhang J et al (for the Consortium on Safe Labor). Contemporary Patterns of Spontaneous Labor With Normal Neonatal Outcomes. Obstet Gynecol 2010; 116:1281.

7. Preventing the First Cesarean Delivery
Active phase arrest
6 cm or greater dilation with membrane rupture and no cervical change for
4 hrs or more of adequate uterine contractions
6 hrs or more if contractions inadequate
Second stage arrest
No progress (descent or rotation) for
3 hrs or more in nulliparous w/o epidural
4 hrs or more in nulliparous with epidural
Spong CY et al. Preventing the First Cesarean Delivery: Summary of a Joint Eunice Kennedy Shriver
National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine,
and American College of Obstetricians and Gynecologists Workshop. Obstet Gynecol;120:1181

8. Preventing the First Cesarean Delivery
Induction of Labor
Labor induction should be performed only for medical indication; if done for nonmedical indications, the gestational age should be 39 weeks or more, and the cervix should be favorable (Bishop score more than 8), especially in the nulliparous patient
Adequate time for normal latent and active phases of the first stage, and for the second stage, should be allowed unless expeditious delivery is medically indicated
Spong CY et al. Preventing the First Cesarean Delivery: Summary of a Joint Eunice Kennedy Shriver
National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine,
and American College of Obstetricians and Gynecologists Workshop. Obstet Gynecol;120:1181

9. Preventing the First Cesarean Delivery
Failed Induction of Labor
40% of women not in active labor after 12 hours of oxytocin and membrane rupture delivered vaginally.
Failure to generate regular contractions and cervical change after at least 24 hours of oxytocin administration with AROM (if feasible) or at least 12 hours after membrane rupture
Rouse DJ, et al. Failed Labor Induction: Toward an Objective Diagnosis. Obstet Gynecol 2011;117:267
Spong CY et al. Preventing the First Cesarean Delivery: Summary of a Joint Eunice Kennedy Shriver
National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine,
and American College of Obstetricians and Gynecologists Workshop. Obstet Gynecol;120:1181

10. Preventing the First Cesarean Delivery
NICHD recommended Quality Measures
Rate of nonmedically indicated cesarean delivery
Rate of nonmedically indicated induction
Rate of labor arrest or failed induction diagnosed without meeting accepted criteria
Rate of cesarean deliveries for nonreassuring fetal heart rate (NICHD Guidelines)
Rate of cesarean section for singleton gestation, vertex presentation, at 37 0/7 to 41 6/7 weeks of gestation
Spong CY et al. Preventing the First Cesarean Delivery: Summary of a Joint Eunice Kennedy Shriver
National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine,
and American College of Obstetricians and Gynecologists Workshop. Obstet Gynecol;120:1181