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- W4200044634 abstract "To study adherence to labor arrest criteria at Yale New Haven Hospital (YNHH) and to examine the impact of a quality improvement (QI) initiative to educate obstetric providers on labor arrest criteria. We performed a retrospective analysis of cesarean deliveries (CDs) performed for arrest of dilation, arrest of descent and failed induction of labor (IOL) among nulliparous, term, singleton, vertex (NTSV) births at YNHH between September 2018 and September 2019. Each labor course was examined by two trained reviewers using ACOG/SMFM guidelines to determine if minimum criteria were met. Our QI educational intervention consisted of pocket cards and posters outlining labor arrest criteria, which were provided to all labor and delivery staff on October 1, 2019. All CDs from October 2019 through March 2020 were evaluated using the same guidelines to determine adherence post educational intervention. Binomial logistic regression determined the odds ratio and confidence intervals for adherence between provider and labor arrest type, pre/post intervention. From September 1, 2018 to September 30, 2019, 1506 CDs were performed. 519 NTSV CDs were performed with 272 for labor arrest: 28.4% (27/95) met criteria for arrest of dilation, 45.9%(51/111) for arrest of descent, and 53.0%(35/66) for failed IOL. Following the educational initiative from October 1, 2019 through March 31, 2020, 802 cesarean deliveries were performed. 209 NTSV CDs were performed with 92 for labor arrest: 65.7%(25/38) met criteria for arrest of dilation, 75.8%(22/29) for arrest of descent, and 88%(22/25) for failed IOL. Providers were 4.2x more likely to be adherent post versus pre-intervention CI[2.4-7.1]. CDs were more likely to adhere to all arrest indications in the post versus pre-intervention period. Labor arrest adherence was suboptimal in the pre-intervention period. A targeted QI initiative positively impacted adherence rates to labor arrest criteria. Future studies aimed to improve adherence to labor arrest criteria should be pursued to optimize CD rates and avoid unnecessary CDs.View Large Image Figure ViewerDownload Hi-res image Download (PPT)" @default.
- W4200044634 created "2021-12-31" @default.
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- W4200044634 date "2022-01-01" @default.
- W4200044634 modified "2023-09-27" @default.
- W4200044634 title "Adherence to labor arrest guidelines: The impact of a quality improvement initiative" @default.
- W4200044634 doi "https://doi.org/10.1016/j.ajog.2021.11.132" @default.
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