Recommended Citation
Pietrzak L, Trenhs S, Lamptey M, Kram JJF, Cox Bauer C . Evaluation of the Adherence to Established Guidelines for Labor Arrest Disorders in Nulliparous, Term, Singleton, Vertex Cesarean Births. Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Abstract
Background/Significance:
The Nulliparous, Term, Singleton, Vertex (NTSV) cesarean birth rate was developed as a quality metric to provide a standardized way of evaluating rates between hospitals with the aim of reducing primary cesarean rates. Currently, in the United States NTSV cesareans account for ~25.6% of births (national benchmark 23.6%). Labor arrest disorders, including failed induction of labor, arrest of cervical dilation, and arrest of fetal descent, account for ~18-35% of primary deliveries, making them one of the more common indications for NTSV cesareans. However, there has been limited evaluation of adherence to American College of Obstetricians and Gynecologists (ACOG) Safe Prevention of the Primary Cesarean Delivery diagnostic criteria for arrest disorders among NTSV cesareans.
Purpose:
To evaluate adherence to established diagnostic criteria for labor arrest disorders among NTSV cesareans.
Methods:
We conducted a quality improvement project within one urban teaching hospital among patients ≥ 37 weeks’ gestation who presented with a singleton, vertex pregnancy and their first live birth between 6/1/2021-6/1/2022. A subgroup of patients who were identified as having a NTSV cesarean and a labor arrest disorder as a documented cause for delivery were further reviewed to determine adherence to the ACOG diagnostic criteria for labor arrest disorders. Neonatal outcomes were also reviewed within this subpopulation. Basic descriptive statistics were computed.
Results:
Of NTSV cesarean deliveries (N=127), 20.5% (N=26) had documentation of labor arrest disorder. Patients were of median age 22.0 years, and were predominately Black, non-Hispanic (48.8%) with a median gestational age of 39w3d. Gestational hypertension was present in 30.0% of patients. Labor was induced in 73.1% of patients and 92.3% had Pitocin augmentation. Only 61.5% (N=16) met ACOG criteria for labor arrest: 50.0% (N=8) criteria for arrest of dilation, 43.8% (N=7) arrest of descent, or 6.3% (N=1) failed induction of labor. Neonates born within this subpopulation had a median 5-min APGAR of 9.0; 19.2% were admitted to the NICU.
Conclusion:
More than one-third of NTSV cesarean deliveries performed for a labor arrest disorder did not meet established ACOG diagnostic criteria, indicating inconsistencies in guideline-concordant labor management. This finding reveals an important opportunity for future targeted quality improvement efforts aimed at strengthening adherence to evidence-based labor arrest criteria.
Presentation Notes
Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Full Text of Presentation
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Document Type
Poster
Open Access
Available to all.
Evaluation of the Adherence to Established Guidelines for Labor Arrest Disorders in Nulliparous, Term, Singleton, Vertex Cesarean Births
Background/Significance:
The Nulliparous, Term, Singleton, Vertex (NTSV) cesarean birth rate was developed as a quality metric to provide a standardized way of evaluating rates between hospitals with the aim of reducing primary cesarean rates. Currently, in the United States NTSV cesareans account for ~25.6% of births (national benchmark 23.6%). Labor arrest disorders, including failed induction of labor, arrest of cervical dilation, and arrest of fetal descent, account for ~18-35% of primary deliveries, making them one of the more common indications for NTSV cesareans. However, there has been limited evaluation of adherence to American College of Obstetricians and Gynecologists (ACOG) Safe Prevention of the Primary Cesarean Delivery diagnostic criteria for arrest disorders among NTSV cesareans.
Purpose:
To evaluate adherence to established diagnostic criteria for labor arrest disorders among NTSV cesareans.
Methods:
We conducted a quality improvement project within one urban teaching hospital among patients ≥ 37 weeks’ gestation who presented with a singleton, vertex pregnancy and their first live birth between 6/1/2021-6/1/2022. A subgroup of patients who were identified as having a NTSV cesarean and a labor arrest disorder as a documented cause for delivery were further reviewed to determine adherence to the ACOG diagnostic criteria for labor arrest disorders. Neonatal outcomes were also reviewed within this subpopulation. Basic descriptive statistics were computed.
Results:
Of NTSV cesarean deliveries (N=127), 20.5% (N=26) had documentation of labor arrest disorder. Patients were of median age 22.0 years, and were predominately Black, non-Hispanic (48.8%) with a median gestational age of 39w3d. Gestational hypertension was present in 30.0% of patients. Labor was induced in 73.1% of patients and 92.3% had Pitocin augmentation. Only 61.5% (N=16) met ACOG criteria for labor arrest: 50.0% (N=8) criteria for arrest of dilation, 43.8% (N=7) arrest of descent, or 6.3% (N=1) failed induction of labor. Neonates born within this subpopulation had a median 5-min APGAR of 9.0; 19.2% were admitted to the NICU.
Conclusion:
More than one-third of NTSV cesarean deliveries performed for a labor arrest disorder did not meet established ACOG diagnostic criteria, indicating inconsistencies in guideline-concordant labor management. This finding reveals an important opportunity for future targeted quality improvement efforts aimed at strengthening adherence to evidence-based labor arrest criteria.
Affiliations
Aurora Sinai Medical Center, Aurora UW Medical Group