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AHRQ Study Finds Quarter of Cesarean Sections May Be Performed Too Early in Labor

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Research Alert: March 31, 2000

Nearly one-quarter of women undergoing cesarean section (c-sections) may have had the procedure too early in their labor, according to a new Agency for Healthcare Research and Quality (AHRQ) study. The study, conducted by researchers at RAND, Brown University, and the University of California and funded by AHRQ, is in the April 1, 2000, Obstetrics and Gynecology.

Of the one million c-sections performed annually, about 294,000 of them are done because of lack of progress in labor. In this study, researchers found that up to 24 percent of the c-sections for lack of progress may be performed too early. These women had a c-section with a dilation of only zero to three centimeters—contrary to recommendations of the American College of Obstetrics and Gynecology (ACOG) that the cervix should be dilated to 4 centimeters or more before the diagnosis is made. In addition, many repeat c-sections occur subsequent to previous c-sections done for lack of progress.

According to the researchers, doctors may be more at ease with risks associated with c-sections, than with those associated with abnormal labors that are not progressing as rapidly as expected. They also conclude that doctors either disagree with ACOG recommendations or interpret them differently. As a result, doctors may formulate their own definition of "lack of progress in labor." The authors suggest that more research is needed to understand the health effects of diagnosing lack of progress earlier in labor and why doctors do not follow the ACOG recommendations.

Researchers reviewed medical records and collected postpartum telephone surveys from 733 women who delivered full term, nonbreech infants by unplanned c-sections. The data were captured from 30 hospitals in Los Angeles County and Iowa between March 1993 and February 1994.

Details are in the April issue of Obstetrics and Gynecology, "Lack of Progress in Labor as a Reason for Cesarean," by Deidre Spelliscy Gifford, M.D., MPH, Sally C. Morton, Ph.D., Mary Fiske, M.D., MPH, Joan Keesey, Emmett Keeler, Ph.D., and Katherine I. Kahn, M.D. The research is part of AHRQ's Patient Outcomes Research Team (PORT) on management and outcomes of childbirth.

Editor's Note: For further details or interviews, call Dr. Gifford at (401) 274-1122, extension 2726.

For additional information, contact AHRQ Public Affairs, (301) 427-1364.

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