ACTIVE MANAGEMENT
OF LABOUR
What is the active management of labour?
N Engl J Med. 1995 Sep 21;333(12):745-50.
A clinical trial of active management of labor.
Frigoletto FD Jr,
Lieberman E,
Lang JM,
Cohen A,
Barss V,
Ringer S,
Datta S.
Department of Obstetrics and Gynecology,
Brigham and Women's Hospital, Boston, MA, USA.
BACKGROUND. Active management of labor is a multifaceted program that, as
implemented at the National Maternity Hospital in Dublin, is associated with a
lower rate of cesarean delivery than the rate usually found in the United
States. We conducted a randomized trial to evaluate the efficacy of this
approach in lowering the rate of cesarean section among women delivering their
first babies.
Methods:
We randomly assigned 1934 nulliparous women at low risk of complications of
pregnancy, before 30 weeks' gestation, to active management of labor or to a
usual-care group. The components of active management were customized childbirth
classes; strict criteria for the diagnosis of labor; standardized management of
labor, including early amniotomy and treatment with high-dose oxytocin; and
one-to-one nursing. A low-risk subgroup was defined as including women with
full-term, uncomplicated pregnancies who spontaneously went into labor (the
protocol-eligible subgroup). Women meeting these criteria who had been randomly
assigned to the active-management group were admitted to a separate unit where
their labor was managed by trained, certified nurse-midwives. RESULTS. There was
no difference between groups in the rate of cesarean section either among all
women (active management, 19.5 percent; usual care, 19.4 percent) or in the
protocol-eligible subgroup (active management, 10.9 percent; usual care, 11.5
percent). In the protocol-eligible subgroup, the median duration of labor was
shortened by 2.7 hours by active management (from 8.9 to 6.2 hours), and the
rate of maternal fever was lower (7 percent vs. 11 percent, P = 0.007). The
percentage of women in whom labor lasted longer than 12 hours was three times
higher in the usual-care group than in the active-management group (26 percent
vs. 9 percent, P < 0.001). CONCLUSIONS. Active management of labor did not
reduce the rate of cesarean section in nulliparous women but was associated with
a somewhat shorter duration of labor and less maternal fever.
What is the active management of labour?
|
N Engl J Med. 1995 Sep 21;333(12):745-50. |
A clinical trial of active management of labor.
Frigoletto FD Jr, Lieberman E, Lang JM, Cohen A, Barss V, Ringer S, Datta S.
Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA.
BACKGROUND. Active management of labor is a multifaceted program that, as implemented at the National Maternity Hospital in Dublin, is associated with a lower rate of cesarean delivery than the rate usually found in the United States. We conducted a randomized trial to evaluate the efficacy of this approach in lowering the rate of cesarean section among women delivering their first babies.
Methods:
We randomly assigned 1934 nulliparous women at low risk of complications of
pregnancy, before 30 weeks' gestation, to active management of labor or to a
usual-care group. The components of active management were customized childbirth
classes; strict criteria for the diagnosis of labor; standardized management of
labor, including early amniotomy and treatment with high-dose oxytocin; and
one-to-one nursing. A low-risk subgroup was defined as including women with
full-term, uncomplicated pregnancies who spontaneously went into labor (the
protocol-eligible subgroup). Women meeting these criteria who had been randomly
assigned to the active-management group were admitted to a separate unit where
their labor was managed by trained, certified nurse-midwives. RESULTS. There was
no difference between groups in the rate of cesarean section either among all
women (active management, 19.5 percent; usual care, 19.4 percent) or in the
protocol-eligible subgroup (active management, 10.9 percent; usual care, 11.5
percent). In the protocol-eligible subgroup, the median duration of labor was
shortened by 2.7 hours by active management (from 8.9 to 6.2 hours), and the
rate of maternal fever was lower (7 percent vs. 11 percent, P = 0.007). The
percentage of women in whom labor lasted longer than 12 hours was three times
higher in the usual-care group than in the active-management group (26 percent
vs. 9 percent, P < 0.001). CONCLUSIONS. Active management of labor did not
reduce the rate of cesarean section in nulliparous women but was associated with
a somewhat shorter duration of labor and less maternal fever.
