Structured Abstract

Contents

• Key Messages
• Preface
• Acknowledgments
• Key Informants
• Technical Expert Panel
• Peer Reviewers
• Evidence Summary
  • Background
  • Methods
  • Results
  • Discussion
  • References
• Introduction
  • Background
  • Scope and Key Questions
  • Organization of This Report
• Methods
  • Topic Refinement and Review Protocol
  • Literature Search Strategy
  • Quality (Risk of Bias) Assessment of Individual Studies
  • Data Synthesis
  • Strength of the Body of Evidence
  • Applicability
  • Peer Review and Public Commentary
• Results
  • Introduction
  • Results of Literature Searches
  • Description of Included Studies
  • Key Question 1. Criteria Used To Define Abnormal Labor
  • Key Question 2. Amniotomy
  • Key Question 3. Supportive Care
  • Key Question 4. Epidural Analgesia
  • Key Question 5. Frequency of Cervical Examination
  • Key Question 6. Intrauterine Pressure Catheters
  • Key Question 7. High-Dose Versus Low-Dose Oxytocin Protocols
  • Key Question 8. Electronic Fetal Monitoring Versus Intermittent Auscultation
  • Key Question 9. Timing of Pushing in the Second Stage
• Discussion
  • Key Findings and Strength of Evidence
  • Findings in Relationship to What Is Already Known
  • Applicability
  • Implications for Clinical and Policy Decision Making
  • Limitations of the Systematic Review Process
  • Research Recommendations
  • Conclusions
• References
• Acronyms and Abbreviations
• Appendixes
  • Appendix A. Exact Search Strings
  • Appendix B. Data Abstraction Elements
  • Appendix C. List of Included Studies
  • Appendix D. List of Excluded Studies
  • Appendix E. Characteristics of Included Studies
  • Appendix F. AMSTAR Quality Assessment for Systematic Reviews
  • Appendix G. Risk of Bias Assessment for Included Studies

Suggested citation:

Myers ER, Sanders GD, Coeytaux RR, McElligott KA, Moorman PG, Hicklin K, Grotegut C, Villers M, Goode A, Campbell H, Befus D, McBroom AJ, Davis JK, Lallinger K, Fortman R, Kosinski A. Labor Dystocia. Comparative Effectiveness Review No. 226. (Prepared by the Duke Evidence-based Practice Center under Contract No. 290-2015-00004-I.) AHRQ Publication No. 29-EHC007. Rockville, MD: Agency for Healthcare Research and Quality; May 2020. DOI: https://doi.org/10.23970/AHRQEPCCER226. Posted final reports are located on the Effective Health Care Program search page.

This report is based on research conducted by the Duke Evidence-based Practice Center under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2015-00004-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.

The information in this report is intended to help healthcare decision makers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of healthcare services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.

This report is made available to the public under the terms of a licensing agreement between the author and the Agency for Healthcare Research and Quality. This report may be used and reprinted without permission except those copyrighted materials that are clearly noted in the report. Further reproduction of those copyrighted materials is prohibited without the express permission of copyright holders.

AHRQ or U.S. Department of Health and Human Services endorsement of any derivative products that may be developed from this report, such as clinical practice guidelines, other quality enhancement tools, or reimbursement or coverage policies, may not be stated or implied.

This report may periodically be assessed for the currency of conclusions. If an assessment is done, the resulting surveillance report describing the methodology and findings will be found on the Effective Health Care Program website at www.effectivehealthcare.ahrq.gov. Search on the title of the report.