8) Diagnosis of arrest of labor
in the 2nd stage may be considered after at least 2 hours of pushing in multiparous women and 3 hours of pushing in nulliparous women, especially if no fetal descent is occurring.
The 2014 ACOG-SMFM consensus statement recommends extending each of these limits by an hour, if maternal and fetal conditions permit, so that we allow at least 3 hours of pushing for nulliparous women and at least 2 hours for multiparous women before diagnosing arrest of labor
in the second stage.
In these cases, arrest of labor
could be due to impaired muscle strength or low calcium levels as a result of vitamin D deficiency.
The book's author is a professor of family medicine at the University of Saskatchewan, leading to occassional unfamiliar practices and terminology for United States readers (eg, lateral collateral ligaments in the ankle, and the recommendation of cesarean section in a laboring patient with secondary arrest of labor
whose labor adequacy is assessed by palpation rather than an intrauterine pressure catheter), but these are few and recognizable.
In my last call as a resident, a patient arrived at L&D after arrest of labor
at 5 cm for many hours.
This pattern suggests that a diagnosis of arrest of labor
before 6 cm of dilation needs to be scrutinized carefully to prevent unnecessary cesarean delivery.
Arrest of labor
was the indication for C-section in 25% of the early epidural group and 21% of the late epidural group, which was not a statistically significant difference, she said.
The injuries to the baby could have been avoided; when an arrest of labor
occurred soon after the mother's arrival at the hospital, a cesarean delivery should have been performed.
With respect to dystocia, failure to progress, cephalopelvic disproportion, arrest of labor
, and so forth, a more scientific approach to labor was called for and evidence-based outcomes regarding length of labor as well as strength of contractions and other factors were promulgated in hopes of decreasing the absolute number of cesarean deliveries from these types of indication.
An arrest of labor
is simply not a reassuring sign and should be deemed as a warning not to push this process.
Other maternal indications in this group consisted of uterine myomas (15%), arrest of labor
(12%), bradycardia (6%), fetal anomalies (6%), multiple gestation (3%), and failure to descend (3%).
Lindsay said that his center first got involved in delayed-interval deliveries when patients with multiple gestations presented in preterm labor and gave birth to the first baby but then the patients had an arrest of labor