Dystocia and Augmentation of Labor
The American College of Obstetricians and Gynecologists has released a practice bulletin on dystocia and augmentation of labor. “ACOG Practice Bulletin Number 49: Dystocia and Augmentation of Labor” appears in the December 2003 issue of Obstetrics and Gynecology and is available online athttp://www.greenjournal.org/cgi/reprint/102/6/1445.
Dystocia, characterized by the slow, abnormal progression of labor, is the leading indication for primary cesarean delivery in the United States. One out of every 10 women who give birth in the United States has had a previous cesarean delivery. Because many repeat cesarean deliveries are performed after primary operations for dystocia, an estimated 60 percent of all cesarean deliveries in the United States are attributable to dystocia. With decreasing rates of vaginal birth after cesarean delivery, dystocia is the leading cause of both operative vaginal delivery and cesarean delivery and their accompanying complications.
Despite the high prevalence of labor disorders, considerable variability exists in the diagnosis, management, and criteria for dystocia that requires intervention.
Among the recommendations are the following:
• Patients should be counseled that walking during labor does not enhance or improve progress in labor, nor is it harmful.
• Continuous support during labor from caregivers should be encouraged because it is beneficial for women and their newborns.
• Active management of labor may shorten labor in nulliparous women, although it has not consistently been shown to reduce the rate of cesarean delivery.
• Amniotomy may be used to enhance progress in active labor but may increase the risk of maternal fever.
• Radiographic pelvimetry alone as a predictor of dystocia has not been shown to have benefit and, therefore, is not recommended.
• Intrauterine pressure catheters may be helpful for women when the evaluation of contractions is difficult because of such factors as obesity.
• Women with twin gestations may undergo augmentation of labor.