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.
Target Audience: Obstetricians and gynecologists, family physicians
Learning Objectives: After completing this CME activity, physicians should be better able to identify the active phase of labor, diagnose an arrest of the active phase, compare the risks and benefits of a prolonged second stage, and identify when an induction has failed.
*Fellow, Maternal-Fetal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH; and †Resident Physician, and ‡Assistant Professor, Department of Obstetrics and Gynecology, University Hospitals Case Medical Center, MacDonald Women's Hospital, Case Western Reserve University, Cleveland, OH
All authors and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations pertaining to this educational activity.
Correspondence requests to: Katherine Rodewald Millen, MD, Maternal-Fetal Medicine, The Ohio State University Wexner Medical Center, 395 West 12th Ave, 5th Floor, Columbus, OH 43210. E-mail: Katherine.Millen@osumc.edu.