ACOG technical bulletin. Dystocia and the augmentation of labor. Number 218--December 1995 (replaces no. 137, December 1989, and no. 157, July 1991). American College of Obstetricians and Gynecologists.

The diagnosis of dystocia is currently a leading indication for cesarean delivery in the United States. Efforts to identify abnormal labor and correct abnormal contraction patterns, fetal malposition, and inadequate expulsive efforts may help eliminate many cesarean deliveries without compromising the outcome for either mother or fetus. Cesarean deliveries for dystocia should not be performed in the latent phase of labor or in the active phase of labor unless adequate uterine activity has been achieved. Cesarean deliveries in the second stage of labor may be reduced if, after reevaluation of the fetus and pelvis, there is potential for correction of uterine forces with oxytocin, correction of malposition, operative vaginal delivery, or safe continued observation. Use of either a low-dose or high-dose oxytocin regimen is appropriate for augmentation of labor. Regardless of the regimen used, oxytocin should be administered by trained personnel capable of responding to complications. A physician who has privileges to perform cesarean delivery should be readily available.