Clinical study of Failure to Progress as an Indication for Cesarean Section / 대한산부인과학회잡지

ABSTRACT

OBJECTIVE: The purpose of this study was to evaluate the appropriateness of diagnosis of the failure to progress (FTP) and accompanying emergency Cesarean section in university hospital and possibility of reducing emergency Cesarean section among these patients. METHODS: Chart review of 680 patients who had underwent emergency Cesarean section with diagnosis of FTP between January 1996 and December 2002 at Hanyang University Medical Center was carried out for this study. Among patients who underwent normal vaginal delivery during the same period, 300 patients were randomly chosen for control group. Comparison between these two groups on maternal physical properties, management during delivery, birth weight and sex of babies were made. Also, differences of labor management among obstetrical staff were compared RESULTS: Compared to the vaginal delivery group, FTP group patients showed older age (29.1 vs 27.7 yr) (p=0.000), shorter stature (158.4 vs 159.8 cm) (p=0.001), and heavier body weight (68.2 vs 65.7 kg) (p=0.000) suggesting unfavorable outcome Also, birth weight of the newborn infant was heavier compared to the normal delivery group (3350 vs 3181 g) (p=0.001). In addition, the frequency of PG E2 use was higher (45% vs 35%) (p=0.001) and hours of oxytocin use was longer (6.3 vs 4.2 hr) (p=0.000) in FTP group. The distribution of delivery time in FTP group was around four or more hours in comparison to the normal delivery group in which the judgement was made that there was as inclination for sufficient effort for the purpose of a normal delivery. On one side, cervical dilatation was less than 3 cm, there were 44 people in a group with less than 70% effacement of cervix in which 40 of these people (excluding 4) were capable for a normal delivery with additional effort. Moreover, in the case of the failure to progress group, active labor management can decrease the rate of cesarean section to about 5.8% (40/680). CONCLUSION: The results of this study suggests the possibility that frequency of cesarean section could be reduced through the efforts of active labor management. However, there are a variety of factors leading to cesarean section that must be analyzed along with social and national support.