Document Detail

Active phase labor arrest: revisiting the 2-hour minimum.
MedLine Citation:
PMID:  11576566     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To generate contemporary uterine activity and labor progress data for oxytocin-augmented labor, and assess whether 2 hours of active phase labor arrest with at least 200 Montevideo units justifies cesarean delivery. METHODS: Five hundred and one consecutive spontaneously laboring term women with abnormally progressive labor were managed by a standardized protocol: oxytocin and intrauterine pressure catheter with an intent to sustain at least 200 Montevideo units for 4 hours or more before cesarean for labor arrest. Uterine activity was measured, and maternal and neonatal outcomes were evaluated. With a sample of this size, the upper 95% confidence interval limit for an event with an observed rate of 1% is below 3%. RESULTS: During oxytocin augmentation, nulliparas who were delivered vaginally dilated at a median rate of 1.4 cm/hour versus 1.8 cm/hour for parous women. In both groups, the 5th percentile of cervical dilation rate was 0.5 cm/hour. Thirty-eight women experienced labor arrest for over 2 hours despite at least 200 sustained Montevideo units; 23 (61%) achieved a vaginal delivery. Rates of chorioamnionitis and endometritis for the 38 women were 26%. None of their infants sustained a serious complication, including brachial plexus injury, even though three of the 23 vaginal deliveries (13%) were complicated by shoulder dystocia. CONCLUSION: These data demonstrate that oxytocin-augmented labor proceeds at substantially slower rates than spontaneous labor, and support our previous contention that the criteria of labor arrest for 2 hours, despite at least 200 sustained Montevideo units, are insufficiently rigorous for the performance of cesarean.
D J Rouse; J Owen; K G Savage; J C Hauth
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Obstetrics and gynecology     Volume:  98     ISSN:  0029-7844     ISO Abbreviation:  Obstet Gynecol     Publication Date:  2001 Oct 
Date Detail:
Created Date:  2001-09-28     Completed Date:  2001-10-18     Revised Date:  2009-10-26    
Medline Journal Info:
Nlm Unique ID:  0401101     Medline TA:  Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  550-4     Citation Subset:  AIM; IM    
Center for Research in Women's Health, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama 35249-7333, USA.
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MeSH Terms
Cesarean Section / statistics & numerical data
Confidence Intervals
Infant, Newborn
Labor Stage, First / drug effects*
Labor, Induced
Obstetric Labor Complications / drug therapy*
Oxytocin / pharmacology,  therapeutic use*
Pregnancy Outcome
Prospective Studies
Time Factors
Uterine Contraction / drug effects
Uterine Monitoring
Grant Support
1-K24HD01375-01/HD/NICHD NIH HHS
Reg. No./Substance:

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