1. PROCEDURE: Cesarean Delivery for Failure to Progress (74 all; subcode dependent on which type of procedure is used)
A. Indication: Lack of progress (failure to progress) (600.61-failed trial of labor; 662.11-long labor) Confirmation of Indication:
(1) No change in either dilation of cervix or descent of presenting part after at least 2 hours of active labor.
(2) Active labor indicated by:
(a) Cervix dilated to at least 3 cm in nullipara or 4 cm in multipara;
(b) Contractions at least every 2-3 minutes;
(c) Strength of contractions at least 50 mm Hg internal pressure as measured by intrauterine catheter or inability to indent fundus on palpation at height of contraction.
B. Prior to Cesarean delivery for failure to progress, the following measures should be taken but not necessarily in the order listed:
(1) Rupture membranes.
(2) In absence of active labor, administer oxytocin to augment labor.
(3) Hydrate patient.
(4) Obtain anesthesia consultation and evaluation.
(5) Ensure that qualified personnel are in attendance for resuscitation and care of newborn (to be determined by each institution).
(6) Informed consent.
(7) Fetal Heart Rate prior to surgery, and
(8) Vaginal examination prior to surgery.
(Reference: Quality Assurance in Obstetrics & Gynecology-1989 ed.)
