Our topic nomination is Labor Dystocia. The following is a list of clinical questions practitioners consider when managing such casesWhat is the appropriate definition and arrest of the following

oLatent labor

oActive labor

oSecond stage

oAfter inductionIn pregnant women near term how does amniotomy versus no amniotomy affect labor For women in labor are there adjunctive interventions that affect labor ambulation nutritionhydration coachingFor women in labor experiencing labor dystocia arepelvimetry results beneficial in informing management decisionsFor women in labor does use of epidural analgesia affect the progress of laborFor women experiencing labor dystocia is there a role for intrauterine pressure catheters in diagnosing dystociaFor women in labor how often should cervical examinations be performed during laborFor women in labor is high dose or low dose oxytocin more likely to affect dystocia and subsequent vaginal delivery. For women in the second stage of labor is there a benefit from delayed or valsalva pushing in the second stage for time to delivery or mode of deliveryFor women in labor undergoing augmentation with oxytocin does use of electronic fetal monitoring improve neonatal outcomesRelevant patients groups or subgroups of peoplePregnant women with labor falling outside the normal course.Important healthrelated benefits and harmsWe are interested in improving sequelae from dystocia such as intrauterine infections prolonged rupture of membranes trauma to the vaginal wall bladder or rectum in the mother and neonate asphyxiation or brain damage causing neonatal morbidity and mortality.

This topic is important because of the risks that labor dystocia poses to the mother and fetus. There are a variety of ways to manage dystocia that need to be considered in a systematic review to be able to provide parameters for defining when labor becomes prolonged and intervention that should be considered.

Clinicians will be more equipped to make appropriate management decisions for labor dystocia based on the needs of the individual patient resources and limitations unique to the institution or type of practice. Recommendations based on the systematic review will be used by clinicians to optimize the success of trials of labor and subsequent vaginal deliveries in appropriate candidates. Related ancillary programs will also benefit. Prolonged labor and dystocia are part of numerous institutions obstetric simulators. A systematic review will provide data to improve these simulators which are used for training residents maintaining individual physician skills team building and communication and patient safety.

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Professional Society

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American College of Obstetricians and Gynecologists

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Stephanie Chang MD MPH Agency for Healthcare Research and Quality