Primiparous women with confirmed delay in labour: incidence and outcomes

Introduction Evidence suggests that the WHO partogram action line based diagnosis of delay is seen in 40% of spontaneously labouring primigravid women, with an overall CS rate of 9%.1 In 2007 NICE Intrapartum Guideline2 suggested modification to the diagnosis of confirmed delay in the 1 st stage of labour taking account of all features of progress and a 2-hour period of suspected delay. Evidence suggested this change would reduce intervention without harm. We present data from a pilot trial of high (4 mu/minute) v standard (2 mu/minute) oxytocin augmentation for delay in the first stage of labour diagnosed using strict NICE criteria. Methods Audit data on incidence of suspected and confirmed delay (from electronic systems and notes) and data on maternal and perinatal outcomes for those recruited were collected. Results The incidence of suspected delay was 11% and of confirmed delay 7%: a third of women made progress in the 2-hour interval. 94 women were recruited from three sites between November 2010 and May 2011. Their mode of birth was spontaneous vaginal birth 23%, instrumental vaginal birth 40%, caesarean birth 34%, 2% withdrew. There were 2 3 rd degree tears and 2 cases of blood loss >1000ml. No infant had a cord artery pH Conclusion Implementation of NICE Guidance for suspected / confirmed delay appears to reduce the incidence of ‘delay in labour’ and hence the overall CS rate. Women with confirmed delay have a high operative birth rate but no significant neonatal morbidity.