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Clinical and Experimental Obstetrics & Gynecology  2020, Vol. 47 Issue (4): 500-504    DOI: 10.31083/j.ceog.2020.04.5272
Original Research Previous articles | Next articles
Fulfillment of the criteria for diagnosis of cephalo-pelvic disproportion: ACOG guidelines
S. Srisukho1, K. Srisupundit1, T. Tongsong1, *()
1Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Thailand
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Abstract  

Purpose: To determine the proportion of cesarean delivery due to CPD without fulfillment of the criteria for diagnosis. Materials and Methods: The obstetric database, between January 2010 and December 2012, was assessed to identify the records of cesarean delivery due to CPD, and the complete medical records were comprehensively reviewed. The degree of adherence to the guidelines on diagnosis of CPD was determined using the criteria recommended by American Congress of Obstetricians and Gynecologists (ACOG) in 2003 compared with that based on the new ACOG 2014 guidelines. Results: During the study period, 475 women underwent cesarean delivery indicated by CPD. The percentages of cases diagnosed with CPD without fulfilling the criteria recommended by ACOG 2003 and ACOG 2014 were 19.37% (92 cases) and 92.42% (432), respectively. Regarding ACOG 2003, cases with non-adherence to the guidelines were mainly associated with diagnosis in the latent phase (55 cases; 11.58%), missed diagnosis for macrosomia in cases of prelabor cesarean section (25 cases; 5.26%), and unfulfilled criteria for diagnosis in the second stage (7 cases; 1.47%). Conclusion: Approximately 19% based on ACOG 2003 guidelines and 92% based on ACOG 2014 guidelines failed to meet the criteria for diagnosis of CPD, suggesting that strengthening diagnosis may reduce a large number of unnecessary cesarean sections.

Key words:  Cesarean delivery      Cephalopelvic disproportion      Guidelines.     
Submitted:  25 May 2019      Accepted:  24 July 2019      Published:  15 August 2020     
Fund: Faculty of Medicine Research Fund, Chiang Mai University, Chiang Mai, Thailand
*Corresponding Author(s):  T. Tongsong     E-mail:  theera.t@cmu.ac.th

Cite this article: 

S. Srisukho, K. Srisupundit, T. Tongsong. Fulfillment of the criteria for diagnosis of cephalo-pelvic disproportion: ACOG guidelines. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(4): 500-504.

URL: 

https://ceog.imrpress.com/EN/10.31083/j.ceog.2020.04.5272     OR     https://ceog.imrpress.com/EN/Y2020/V47/I4/500

Table 1  — Labor characteristics of the cases diagnosed for CPD based on ACOG 2003 and ACOG 2014 guidelines.
Total CPD (n: 475) ACOG 2003 guidelines No. of cases Percent ACOG 2014 guidelines No. of cases Percent
Unfulfilled criteria 92 19.37 Unfulfilled criteria 439 92.42
Fulfilled criteria 383 80.63 Fulfilled criteria 36 7.58
Labor characteristics Prelabor / latent phase 80 16.84 Prelabor / Cx < 6 cm 186 39.16
Protracted dilatation 14 2.95 Cx > 6 cm, UA < 4 hr 217 45.68
Arrest of dilatation 327 68.84 Cx > 6 cm, UA > 4 hr 31 6.53
Prolonged deceleration 13 2.74 Normal 2nd stage 37 7.79
Abnormal 2nd stage 41 8.63 Abnormal 2nd stage 4 0.84
UA adequacy (n: 469) Adequate 436 92.96 Adequate 108 23.03
Inadequate 33 7.04 Inadequate 361 76.97
Suspected macrosomia
(n: 30)
Less than < 4500 g 25 83.33 Less than 5000 g 30 100.00
4500 g or more 5 16.67 5000 g or more 0 0.00
Table 2  — Clinical parameters contributing to probability of vaginal delivery (n: 475*).
No. of cases Percent
Molding Non-significant 229 74.59
Significant 78 25.41
Total 307 100.00
Molding AND Inadequacy of pelvis One or none 367 92.21
Both 31 7.79
Total 398 100.00
Molding AND Significant caput
AND Inadequacy of pelvis
One or two or none 385 96.73
All 13 3.27
Total 398 100.00
Molding AND Significant caput One or none 260 83.60
Both 51 16.40
Total 311 100.00
Adequacy of pelvimetry Adequate 149 33.94
Inadequate 141 32.12
Equivocal 149 33.94
Total 439 100.00
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