Compared to vaginal delivery, cesarean delivery has greater risk of maternal severe morbidity and mortality. The international healthcare community has defined an ideal prevalence of cesarean delivery to be between 10% to 15%. Currently in the United States, one in three women give birth by cesarean delivery.
Several approaches have been used to decrease the prevalence of cesarean delivery. One of the main strategies includes the prevention of primary cesarean delivery, which decreases long-term risks and lowers the repeat cesarean delivery rate. ACOG summarizes recommendations to safely avoid the first cesarean section.
Most common indications for cesarean delivery (starting with most frequent) include
ACOG states that
Because they are contemporary and robust, it seems that the Consortium on Safe Labor data, rather than the standards proposed by Friedman, should inform evidence-based labor management
Note: There is an association between duration of first stage of labor and chorioamnionitis, but causality is unclear
Note: Use of an algorithm, such as the Shields algorithm or Clark algorithm, may help guide management of Category II tracings (see ‘Primary Sources – Learn More’ below)
Elective Induction of Labor at 39 weeks
Note: Allow 24 h or more in the latent phase before diagnosing failed induction | Rupture of membranes and oxytocin for 12 to 18 hours must be present prior to diagnosis of failed induction
Excessive Maternal Weight Gain
Herpes Simplex Virus
Organizational level interventions
ACOG Obstetric Care Consensus 1: Safe Prevention of the Primary Cesarean Delivery
ACOG Practice Bulletin 221: External Cephalic Version
ACOG Practice Bulletin 219: Operative Vaginal Birth
CMQCC: Addendum Toolkit to Support Vaginal Birth and Reduce Primary Cesareans
A Standardized Approach for Category II Fetal Heart Rate with Significant Decelerations: Maternal and Neonatal Outcomes (Shields)
Intrapartum Management of Category II Fetal Heart Rate Tracings: Towards Standardization of Care (Clark)
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