Given these conclusions, it is worthwhile to examine ways
in which the primary cesarean rate may be lowered. Most
cesareans occur during labor, primarily for two indications:
(1) cephalo-pelvic disproportion or failure to progress in
labor; or (2) ‘fetal distress’ or nonreassuring fetal heart rate.
Several recent studies have suggested that with increased
patience in the setting of a diagnosis of active phase arrest, that
33 [26] to 61% [27] of women would go on to delivery
vaginally. A common cause of active phase arrest or failure to
descend in the second stage is fetal malposition. Recent work
suggests that manual rotation of the malpositioned fetal
occiput may reduce the risk of cesarean delivery as well
[23]. In terms of nonreassuring fetal heart rate, while
cesareans for this indication have increased over the past
decade, neonatal outcomes have not improved. Perhaps,
careful re-evaluation of the definition of a nonreassuring fetal
heart rate may help turn the tide on primary cesarean delivery.
Unfortunately, however, the recent study of fetal pulse
oximetery did not actually lower the cesarean delivery rate
[28].
Given these conclusions, it is worthwhile to examine ways
in which the primary cesarean rate may be lowered. Most
cesareans occur during labor, primarily for two indications:
(1) cephalo-pelvic disproportion or failure to progress in
labor; or (2) ‘fetal distress’ or nonreassuring fetal heart rate.
Several recent studies have suggested that with increased
patience in the setting of a diagnosis of active phase arrest, that
33 [26] to 61% [27] of women would go on to delivery
vaginally. A common cause of active phase arrest or failure to
descend in the second stage is fetal malposition. Recent work
suggests that manual rotation of the malpositioned fetal
occiput may reduce the risk of cesarean delivery as well
[23]. In terms of nonreassuring fetal heart rate, while
cesareans for this indication have increased over the past
decade, neonatal outcomes have not improved. Perhaps,
careful re-evaluation of the definition of a nonreassuring fetal
heart rate may help turn the tide on primary cesarean delivery.
Unfortunately, however, the recent study of fetal pulse
oximetery did not actually lower the cesarean delivery rate
[28].
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