title: Prevention of primary caesarean delivery: comprehensive management of dystocia in nulliparous patients at term.
abstract: Dystocia is the leading indication for primary caesarean sections. Our aim is to compare two approaches in the management of dystocia in labor in nulliparous women with a singleton fetus in cephalic presentation at term in spontaneous or induced labor.
  
  
  
  Prospective cohort study. Four hundred and nineteen consecutive patients were divided into two groups: the standard management group (SM), in acceleration of labor was commenced at the "action line" in the case of arrested or protracted labor, and the comprehensive management group (CM) in which arrested or protracted labor was considered as a warning sign promoting further diagnostic assessment prior to considering intervention.
  
  
  
  Caesarean sections rate was 22.2 % in the SM group (216 patients) and 10.3 % in the CM group (203 patients) (p = 0.001). The rate of oxytocin use decreased from 33.3 % in SM group to 13.8 % in the CM group (p < 0.0005). The rate of amniotomy decreased from 41.7 % in the SM group to 7.4 % in the CM group (p < 0.0005). The percentage of newborns with 5-min Apgar score <7 and/or umbilical cord arterial pH ≤ 7.00 decreased from 2.3 % in SM cohort to 0.5 % in CM cohort (p = ns). The average length of labor did not differ between the two groups of patients (264 vs 277 min; p = ns).
  
  
  
  Comprehensive management of dystocia enabled us to achieve a reduction in iatrogenic interventions in labor while maintaining good neonatal outcomes.
authors.affiliation: Dipartimento Materno Infantile, U.O.C. di Ginecologia e Ostetricia, Massa Carrara Hospital, Via Enrico Mattei 21, 54100, Massa Carrara, Italy. antonio.ragusa@gmail.com.
authors.forename: Antonio
authors.initials: A
authors.lastname: Ragusa
authors.affiliation: Dipartimento di Salute della Donna e del Bambino, U.O.C. di Ginecologia e Ostetricia, University of Padua, Via Giustiniani 3, 35128, Padua, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Gizzo
authors.affiliation: Dipartimento di Salute della Donna e del Bambino, U.O.C. di Ginecologia e Ostetricia, University of Padua, Via Giustiniani 3, 35128, Padua, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Noventa
authors.affiliation: Department of Woman, Mother and Newborn, School of Medicine, Ospedale "V. Buzzi", Milan, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Ferrazzi
authors.affiliation: Department of Obstetrics and Gynaecology, San Giovanni di Dio General Hospital, University of Cagliari, Cagliari, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Deiana
authors.affiliation: Department of Obstetrics and Gynaecology, Carlo Poma General Hospital, Mantua, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Svelato
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000379:methods*; D015331:Cohort Studies; D004420:Dystocia / Q000628:therapy*; D005260:Female; D006801:Humans; D007751:Labor, Induced / Q000009:adverse effects*; D011247:Pregnancy; D011446:Prospective Studies
keywords: Cesarean section; Intrapartum strategy; Labor augmentation; Labor dystocia; Nulliparity; Partogram