Abnormal labor management

Question 1

What percent of primary C-sections are for maternal request?

Answer 1

3% (based on 2011 data)

Question 2

What are the two most common indications for primary C-section?

Answer 2

Labor arrest (34%) and non-reassuring FHT (23%)

Question 3

Definition of adequate contractions

Answer 3

200 Montevideo units

Question 4

In patients for whom an operative delivery is attempted, what percentage go on to have C-section?

Answer 4

3% (Cochrane Database Syst Rev. 2010 Nov 10;(11):CD005455.)

Question 5

What adverse neonatal outcomes are related to prolonged duration of 2nd stage of labor?

Answer 5

None, based on several studies of nulliparous women

• Rouse DJ, et al. Second-stage labor duration in nulliparous women: relationship to maternal and perinatal outcomes. Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Am J Obstet Gynecol 2009;201:357. e1–357.e7.
• Le Ray C, et al. When to stop pushing: effects of duration of second-stage expulsion efforts on maternal and neonatal outcomes in nulliparous women with epidural analgesia. Am J Obstet Gynecol 2009;201:361.e1–361.e7.
• Cheng YW, Hopkins LM, Caughey AB. How long is too long: Does a prolonged second stage of labor in nulliparous women affect maternal and neonatal outcomes? Am J Obstet Gynecol 2004;191:933–8.

Question 6

After 3 hours of pushing, what proportion of nulliparous women will go on to have a spontaneous vaginal delivery?

Answer 6

One in four

Rouse DJ, et al. Second-stage labor duration in nulliparous women: relationship to maternal and perinatal outcomes. Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Am J Obstet Gynecol 2009;201:357. e1–357.e7.