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Obstetric Quality and Safety

Poster Session 2

(562) Factors associated with non-adherence to ACOG guidelines for labor arrest disorders

Tuesday, February 13, 2024
3:30 PM – 5:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Foundation Awardee
Objective: The ACOG/SMFM Safe Prevention of Primary Cesarean Delivery guidelines provide minimum time criteria at which cesarean delivery (CD) should be performed for a labor arrest disorder. Despite these guidelines, national adherence remains inadequate. We sought to evaluate clinic factors associated with non-adherence to ACOG guidelines for labor arrest diagnoses.

Study Design: This is a case-control study of patients who underwent CD for labor arrest disorders from 2018-2021 at a single center. Charts were reviewed for adherence to the Safe Prevention of the Primary Cesarean Delivery criteria for failed induction of labor, arrest in the active phase, and second stage arrest. Cases were patients who underwent CD prior to meeting minimum ACOG time criteria for labor arrest.  Controls were patients who met ACOG criteria for diagnosis of labor arrest. Maternal, fetal, and unit-level factors were compared between cases and controls.  

Results: Of 376 patients with CD for arrest disorders, 206 (55%) met minimum ACOG criteria (controls) and 170 (45.2%) did not (cases).  Non-adherence was significantly more common when the obstetrician managed labor remotely compared to in-house obstetricians (54% vs 28%, P= < 0.001). Non-adherence was also more common when Category II tracing was present and was associated with certain types of labor arrest; providers were more likely to adhere to guidelines for failed induction of labor and less likely to adhere to guidelines for second-stage arrest. Providers were more likely to adhere to guidelines for patients with obesity.  Factors such as time of day, parity, and co-morbidities did not influence adherence.

Conclusion: Maternal, fetal, intrapartum, and unit-level factors influence adherence to ACOG guidelines for labor arrest disorders. Addressing modifiable factors such as provider location may improve adherence and potentially decrease cesarean section rates.