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Vaginal delivery possible even if active phase labor arrest exceeds 2 hours

מתוך medicontext.co.il

WESTPORT, CT (Reuters Health) – Because oxytocin-augmented labor proceeds more slowly than spontaneous labor, 2 hours of active phase labor arrest with at least 200 Montevideo units is not a rigorous enough criterion for cesarean section, US researchers maintain in the October issue of Obstetrics and Gynecology.

Dr. Dwight J. Rouse and colleagues from the University of Alabama at Birmingham collected data on 501 consecutive women with term pregnancies whose spontaneous labor arrested. The women were managed with oxytocin and intrauterine pressure catheter with the goal of sustaining a uterine contraction pattern of at least 200 Montevideo units for 4 hours or more before a cesarean was performed.

Among the women who delivered vaginally, dilation during oxytocin augmentation progressed at a median rate of 1.4 cm/hour for nulliparas and 1.8 cm/hour for parous women. For women who eventually required cesarean delivery, the respective figures were 0.3 cm/hour and 0.4 cm/hour, Dr. Rouse's team reports.

More than half of women, 54%, achieved at least 200 Montevideo units after oxytocin was initiated. Labor arrest continued for more than 2 hours in 38 women despite this level of uterine activity.

Of these 38 women, 23 (61%) had a vaginal delivery without a serious sustained complication in the infants, the research team found. Three deliveries were complicated by shoulder dystocia.

These data "confirm that the majority of women who experience 2 hours of labor arrest despite a sustained uterine contraction pattern of at least 200 Montevideo units will achieve vaginal delivery if oxytocin augmentation is continued," the investigators say. "Moreover, the infants of such women were no more likely to experience complications than infants of women whose labor progressed in a more normal fashion."

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