Labor trouble starts early: first-stage flags precede second-stage C-sections.(Obstetrics)

HOUSTON -- Charts of women undergoing second-stage caesarean deliveries due to dysfunctional labor or presumed cephalopelvic disproportion often contain first-stage harbingers of trouble that go unrecognized by obstetricians, investigators reported at the annual meeting of the Society for Gynecologic Investigation.

Researchers assessed labor patterns in the charts of 31 mothers who delivered term singletons in the second stage of labor during 2002, comparing the data with charts of 31 control patients who delivered in the first stage of labor for the same indications in the same time period.

In 29 of 31 second-stage delivery cases, some element of second-stage labor dysfunction was documented, including arrest of descent in 20 patients, failure of descent in 8, and protracted descent in 2, with 3 deliveries representing a combination of disorders, according to investigators at Jamaica Hospital Medical Center and Weill-Cornell Medical, New York.

First-stage labor abnormalities preceded abnormal descent in 23 of these 29 cases, but these went unrecognized by the obstetrician in 17 cases. Importantly, a first-stage prolonged deceleration phase (excess time in the terminal portion of dilatation) complicated the labor in more than half of cases, probably because full dilatation generally cannot be accomplished without some descent.

"Also, the diagnosis [of the precise labor abnormality] made by the obstetrician managing the labor was often incorrect, or at least ...