Original ArticlesActive-phase labor arrest: oxytocin augmentation for at least 4 hours
Section snippets
Material and methods
The protocol was instituted on February 1, 1996 at the Maternal-Fetal Medicine service of the University of Alabama at Birmingham Hospital, which has approximately 3000 deliveries annually. Deliveries on this service are performed by resident physicians under the direct 24-hour supervision of one of 11 members (faculty and fellows) of the Maternal-Fetal Medicine Division.
All members of the Maternal-Fetal Medicine Division agreed to manage eligible women according to protocol. Before institution
Results
From February 1, 1996 through April 6, 1998, 554 protocol-eligible women experienced active-phase labor arrest. Twelve (2%) of these women did not receive oxytocin because of spontaneous progress of labor before initiation of the drug. These women all delivered vaginally, and because they did not receive oxytocin, they were not considered further in the analysis of this protocol. Thus, 542 women were eligible for the protocol and received oxytocin.
Of the women managed by the protocol, 288 (53%)
Discussion
We conducted the present investigation to evaluate a protocol that focused on three principal elements: 1) an intent to achieve a sustained uterine contraction pattern of greater than 200 Montevideo units; 2) a more liberal minimum of 4 hours (as opposed to the currently sanctioned 2 hours5) of oxytocin-augmented labor arrest with a sustained uterine contraction pattern of greater than 200 Montevideo units before proceeding to cesarean delivery for active-phase labor arrest; and 3) for patients
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The evolution of the labor curve and its implications for clinical practice: the relationship between cervical dilation, station, and time during labor
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2023, American Journal of Obstetrics and GynecologyRefining the clinical definition of active phase arrest of dilation in nulliparous women to consider degree of cervical dilation as well as duration of arrest
2021, American Journal of Obstetrics and GynecologyCitation Excerpt :Currently, arrest of dilation is defined as no cervical change after a cervical dilation of 6 cm with membrane rupture, with 1 of the following: (1) 4 hours or more of adequate contractions or (2) 6 hours or more of inadequate contractions.2 Rouse et al3 in 1999 found that extending the minimum period of oxytocin augmentation for arrest of dilation to at least 4 hours instead of 2 hours would safely increase the rate of vaginal delivery. Subsequently, other studies confirmed that requiring at least 4 hours of oxytocin augmentation before diagnosing arrest of dilation increases the rate of vaginal delivery without increasing neonatal complications.4,5
Is Zhang the new Friedman: How should we evaluate the first stage of labor?
2020, Seminars in PerinatologyContemporary patterns of labor in nulliparous and multiparous women
2020, American Journal of Obstetrics and GynecologyCitation Excerpt :Indeed, recent studies have questioned the prescribed “common” durations of labor stages,13–16 challenging the well-defined relationship between cervical dilation and duration of the first stage of labor and the definitions of protracted and arrested labor. Almost 2 decades ago, Rouse et al17 revisited the 2-hour rule of active phase labor arrest, extending it to a 4-hour rule.18 The World Health Organization retained the action straight diagonal line in the active phase (defined as ≥4 cm), which is drawn 4 hours to the right of and parallel to the alert line,3 where labor progressed at a rate of <1 cm cervical dilation per hour.