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New study finds that each year thousands of c-sections are performed too early in labor

Of the 1 million c-sections performed in the United States each year, about 294,000 are done because of lack of progress in labor. A recent study found that up to 24 percent of the c-sections done for lack of progress may be performed too early. These women had a c-section with a dilation of only 0 to 3 centimeters contrary to recommendations of the American College of Obstetricians and Gynecologists (ACOG) that the cervix should be dilated to 4 centimeters or more before a diagnosis of failure to progress is made.

The study was conducted by researchers at RAND, Brown University, and the University of California, Los Angeles, and funded by the Agency for Healthcare Research and Quality (contract 290-90-0039). The study was part of AHRQ's Management and Outcomes of Childbirth Patient Outcomes Research Team (PORT), led by Emmett Keeler, Ph.D., of RAND.

According to the researchers, doctors may be more at ease with risks associated with c-sections than they are with continuing to observe a labor in the second stage that is not progressing as rapidly as expected. Also, doctors may either disagree with the ACOG recommendations or interpret them differently. As a result, doctors may formulate their own definition of "lack of progress in labor." The authors point to the need for more research 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 "Lack of progress in labor as a reason for cesarean," by Deidre Spelliscy Gifford, M.D., M.P.H., Sally C. Morton, Ph.D., Mary Fiske, M.D., M.P.H., and others in the April 2000 Obstetrics & Gynecology, 95, pp. 589-595.

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