Audit of Caesarean Section for Non-Progress of Labor: A Clinical Findings

Background: There is alarming increase in the number of caesarean section in the recent past years and many of the indications are due to non-progress of labor. Identification of non-progress of labour is crucial so that its proper evaluation and management can result in favourable outcome. Non-progress of labour can result in fatal outcome for mother and baby. This chapter evaluate various parameters and associated factors responsible for non-progress of labor and to study the neonatal outcome.

Methods: Retrospective case record analysis of the obstetric outcome in 42 patients who underwent caesarean section for non-progress of labour was undertaken at PCMS for the period of one year from June 2013-June 2014. Factors like age, parity, gestational age, duration of prolonged labor, maternal and neonatal outcome was analyzed.

Results: In our study mean age of the women who underwent caesarean section for non-progress of labor was 25 years±2.26. When the duration of labor was analyzed, maximum cases i.e. 60% non-progress of labor is seen in active phase, 30% cases had prolonged latent phase of labor, arrest of descent was observed in 10% of cases. There were 14 babies who were shifted to NICU, out of them 10 babies had Apgar score <7. Average baby weight was 2689grams±446.60. Increase in the baby weight might be one of the factors associated with non- progress of labour in second stage, However, in the present study mean weight was 2.8 kg.

Conclusions: Maximum cases 60% were in active phase, 10% with non-progress in second stage of labor. Out of total cases, 33% of newborns had NICU admission, out of them 16% had poor Apgar score but rate of NICU admission due to non-progress of labor remained same. Hence early decision making in caesarean section will help in preventing neonatal complication. There was no neonatal mortality observed in the study. Increased clinical skill and a good documentation of the progress of labour in birth records are of great importance to identify and classify prolonged labour, careful management of interventions is crucial to keep normal births normal and avoid mistreatment.