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Evidence-Based Guidelines in Labor Management

Millen, Katherine Rodewald MD*; Kuo, Kelly MD; Zhao, Lulu MD; Gecsi, Kimberly MD

Obstetrical & Gynecological Survey: April 2014 - Volume 69 - Issue 4 - p 209–217
doi: 10.1097/OGX.0000000000000057

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:

© 2014 by Lippincott Williams & Wilkins.