Lack of progress in labor as a reason for cesarean

Objective: To estimate the prevalence of lack of progress in labor as a rea son for cesarean delivery and to compare published diagnostic criteria with the labor characteristics of women with this diagnosis. Methods: We reviewed medical records and did a postpartum telephone survey to collect data from 733 women who delivered full-term, nonbreech infants b y unplanned cesarean between March 1993 and February 1994. These were a sub set of 2447 births sampled at delivery from 30 hospitals in Los Angeles Cou nty and Iowa. We measured the proportion of unplanned cesareans done for la ck of progress in labor, the cervical dilatation at the time of cesarean, l ength of the second stage, and slope of the active phase among the women. W e estimated the proportion of these cesareans that conformed to the ACOG cr iteria for the diagnosis of lack of progress. Results: Lack of progress was a reason for 68% of unplanned, vertex cesarea ns. At least 16% of the subjects who had cesareans for lack of progress wer e in the latent phase of labor according to ACOG criteria. The second stage was not prolonged in 36% of the women who delivered at 10 cm. Conclusion: Lack of progress in labor is a dominant reason for cesarean del ivery. Many cesareans are done during the latent phase of labor, and in the second stage of labor when it is not prolonged. These practices do not con form to published diagnostic criteria for lack of progress. (C) 2000 by The American College of Obstetricians and Gynecologists.