title: Evidence-based guidelines in labor management.
abstract: Evidence-based care of women in labor requires a thorough understanding of both "normal" and abnormal labor progress. In response to the growing cesarean delivery rate for dystocia at our institution, a multidisciplinary team of attending physicians, nurse-midwives, resident physicians, and nurses was established to review the literature and create evidence-based guidelines. This article describes the background literature and consensus guidelines reached for the diagnosis of active phase labor, active phase arrest, second-stage arrest, protraction of the active phase, and failed induction of labor. Our review illustrates that slower labor patterns than traditionally described often result in a vaginal delivery without unacceptable increases in maternal or neonatal morbidity.
authors.affiliation: Fellow, Maternal-Fetal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH.
authors.forename: Katherine Rodewald
authors.initials: KR
authors.lastname: Millen
authors.affiliation: Resident Physician, Department of Obstetrics and Gynecology, University Hospitals Case Medical Center, MacDonald Women's Hospital, Case Western Reserve University, Cleveland, OH.
authors.forename: Kelly
authors.initials: K
authors.lastname: Kuo
authors.affiliation: Resident Physician, Department of Obstetrics and Gynecology, University Hospitals Case Medical Center, MacDonald Women's Hospital, Case Western Reserve University, Cleveland, OH.
authors.forename: Lulu
authors.initials: L
authors.lastname: Zhao
authors.affiliation: Assistant Professor, Department of Obstetrics and Gynecology, University Hospitals Case Medical Center, MacDonald Women's Hospital, Case Western Reserve University, Cleveland, OH.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Gecsi
mesh_terms: D000328:Adult; D036861:Delivery, Obstetric / Q000379:methods*; D004502:Education, Medical, Continuing; D019317:Evidence-Based Medicine / Q000379:methods*; D005260:Female; D006801:Humans; D007751:Labor, Induced / Q000379:methods*; D007743:Labor, Obstetric / Q000502:physiology*; D059408:Pain Management / Q000379:methods*; D017410:Practice Guidelines as Topic; D011247:Pregnancy