Perinatal outcomes in the setting of active phase arrest of labor.
OBJECTIVE
To examine the association between active phase arrest and perinatal outcomes.


METHODS
This was a retrospective cohort study of women with term, singleton, cephalic gestations diagnosed with active phase arrest of labor, defined as no cervical change for 2 hours despite adequate uterine contractions. Women with active phase arrest who underwent a cesarean delivery were compared with those who delivered vaginally, and women who delivered vaginally with active phase arrest were compared with those without active phase arrest. The association between active phase arrest, mode of delivery, and perinatal outcomes was evaluated using univariable and multivariable logistic regression models.


RESULTS
We identified 1,014 women with active phase arrest: 33% (335) went on to deliver vaginally, and the rest had cesarean deliveries. Cesarean delivery was associated with an increased risk of chorioamnionitis (adjusted odds ratio [aOR] 3.37, 95% confidence interval [CI] 2.21-5.15), endomyometritis (aOR 48.41, 95% CI 6.61-354), postpartum hemorrhage (aOR 5.18, 95% CI 3.42-7.85), and severe postpartum hemorrhage (aOR 14.97, 95% CI 1.77-126). There were no differences in adverse neonatal outcomes. Among women who delivered vaginally, women with active phase arrest had significantly increased odds of chorioamnionitis (aOR 2.70, 95% CI 1.22-2.36) and shoulder dystocia (aOR 2.37, 95% CI 1.33-4.25). However, there were no differences in the serious sequelae associated with these outcomes, including neonatal sepsis or Erb's palsy.


CONCLUSIONS
Efforts to achieve vaginal delivery in the setting of active phase arrest may reduce the maternal risks associated with cesarean delivery without additional risk to the neonate.


METHODS
II.
Henry
Dana E M
DE
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California 94143, USA.
Cheng
Yvonne W
YW
Shaffer
Brian L
BL
Kaimal
Anjali J
AJ
Bianco
Katherine
K
Caughey
Aaron B
AB
D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D002821:Chorioamnionitis / Q000209:etiology; D004420:Dystocia; D004716:Endometritis / Q000209:etiology; D005113:Extraction, Obstetrical / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007748:Labor Stage, Second; D016017:Odds Ratio; D011247:Pregnancy; D012189:Retrospective Studies