Understanding Arrest of Descent, also known as Labor Arrest or Failure to Progress in Descent, is crucial for accurate clinical documentation and medical coding. This resource provides information on diagnosing and managing an arrest of descent during labor, including common causes, risk factors, and treatment options. Learn about relevant ICD-10 codes, documentation best practices, and strategies for optimizing healthcare workflows related to labor arrest.
Also known as
Arrest of Labor and Delivery
Covers obstructed labor due to inadequate contractions or fetal descent issues.
Prolonged 1st stage of labor
Includes slow cervical dilation, potentially leading to descent arrest.
Prolonged 2nd stage of labor
Covers delayed fetal expulsion after full dilation, often related to descent problems.
Follow this step-by-step guide to choose the correct ICD-10 code.
Is the arrest of descent due to cephalopelvic disproportion?
Yes
Code O64.1, Cephalopelvic disproportion
No
Is there obstructed labor due to malposition?
When to use each related code
| Description |
|---|
| Slowed or stopped fetal descent during labor. |
| Slowed or stalled cervical dilation during labor. |
| Lack of cervical change in latent phase of labor. |
Miscoding prolonged first stage of labor as arrest of descent due to similar documentation. Requires careful review of cervical dilation progress.
Failing to document CPD as a contributing factor to arrest of descent, impacting severity and reimbursement.
Lack of specific documentation about the station of fetal descent leading to coding inaccuracies and queries.
Q: What are the diagnostic criteria for arrest of descent during the second stage of labor, and how can I differentiate it from protracted descent?
A: Arrest of descent, also known as labor arrest or failure to progress in descent, is diagnosed in the second stage of labor when there is no descent of the fetal presenting part despite adequate uterine contractions and pushing for a defined period. Specifically, this is generally defined as greater than or equal to 3 hours of pushing in nulliparous women with epidural anesthesia, greater than or equal to 2 hours in multiparous women with epidural anesthesia, or greater than or equal to 2 hours in nulliparous and greater than or equal to 1 hour in multiparous women without epidural anesthesia. It's crucial to differentiate arrest of descent from protracted descent, which refers to a slower-than-normal rate of descent. Protracted descent is managed expectantly with continued support and evaluation, while arrest of descent often necessitates intervention such as operative vaginal delivery or cesarean section. Accurate diagnosis depends on careful assessment of the three Ps: Power (uterine contractions), Passenger (fetal size and position), and Passage (maternal pelvis). Explore how dynamic ultrasound can aid in assessing fetal head position and descent. Consider implementing standardized protocols for diagnosing and managing labor abnormalities to ensure optimal outcomes.
Q: What are the common risk factors and evidence-based management strategies for arrest of fetal descent in the second stage of labor?
A: Several risk factors can predispose to arrest of descent, including epidural analgesia, nulliparity, fetal malposition (e.g., occiput posterior), macrosomia, and cephalopelvic disproportion. Management of arrest of descent requires a comprehensive assessment of the maternal and fetal condition. Options include operative vaginal delivery (using forceps or vacuum) if the fetal head is engaged and the criteria for safe instrumental delivery are met. Cesarean delivery is indicated if operative vaginal delivery is not feasible or safe. Consider implementing strategies to optimize fetal positioning during labor, such as maternal position changes. Learn more about the risks and benefits of different intervention strategies to facilitate shared decision-making with the patient. Maternal and fetal surveillance are paramount throughout the second stage to ensure safety.
Patient presents with arrest of descent, also documented as labor arrest or failure to progress in descent, during the second stage of labor. Cervix is fully dilated at 10 cm, and membranes are ruptured. Adequate uterine contractions have been documented by palpation andor internal intrauterine pressure catheter monitoring, yet fetal descent has ceased for greater than or equal to two hours in a nulliparous patient with regional anesthesia or greater than or equal to three hours in a nulliparous patient without regional anesthesia. For a multiparous patient, arrest of descent is diagnosed after greater than or equal to one hour with regional anesthesia or greater than or equal to two hours without regional anesthesia. Fetal station and position have been confirmed via vaginal examination. Maternal vital signs remain stable. Fetal heart rate monitoring demonstrates a Category I tracing. Potential contributing factors for failure to progress, including cephalopelvic disproportion, fetal malposition, and inadequate uterine contractions, have been considered. Management options, including operative vaginal delivery via forceps or vacuum-assisted delivery and cesarean delivery, were discussed with the patient. Risks and benefits of each intervention were explained. Patient decision regarding mode of delivery will be documented. Continued monitoring of maternal and fetal well-being will be maintained.