ACTIVE MANAGEMENT
OF LABOUR
What is the active management
of labour?
BJOG.
2003 May;110(5):457-61.
Aggressive or expectant management of labour:
a randomised clinical trial.
MRC Maternal and Infant Health Strategies Research Unit, Department of
Obstetrics and Gynaecology, Kalafong Hospital and University of Pretoria,
South Africa.
Objectives:
To compare labour outcomes using aggressive or expectant
management protocols.
Design:
Randomised trial.
Setting:
Pretoria Academic
Complex, South Africa. It serves an indigent urban population. POPULATION:
Healthy nulliparous women in active labour, at term, with a health singleton
pregnancy and cephalic presentation.
Methods:
The women were randomised to
either aggressive (n = 344) or expectant (n = 350) management protocols.
Aggressive management entailed using a single line partogram, a vaginal
examination every two hours and use of an oxytocin infusion if the line was
crossed. Expectant management entailed using a two line partogram, with the
alert line and a parallel action line four hours to the right, with a
vaginal examination every four hours. If the action line was reached,
oxytocin was started. The women were reassessed every two hours thereafter.
Analgesia was prescribed on request.
Main Outcome Measures:
Mode of birth,
use of oxytocin and analgesia and neonatal outcome.
Results:
The groups were
similar with respect to maternal age, cervical dilation at trial entry,
number crossing the alert line and birthweight of the infants. Significantly
fewer women managed aggressively had caesarean sections (16.0%) than those
managed expectantly (23.4%) (relative risk [RR] 0.68, 95% confidence
intervals [CI] 0.50, 0.93). Significantly more oxytocin was used in the
aggressive management group, but there was no difference with respect to the
use of analgesia or episiotomy or in neonatal outcome with respect to the
Apgar score at 1 or 10 minutes. There were three perinatal deaths. One woman
was found to have an intrauterine death before trial entry and the other two
were in the aggressive management group but did not receive oxytocin.
Compliance by staff was poor in the aggressive management group.
Conclusions:
Aggressive management of labour reduces the caesarean section
rate in nulliparous women but requires more intensive nursing.
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What is the active management of labour?
BJOG.
2003 May;110(5):457-61. Aggressive or expectant management of labour:
a randomised clinical trial.
MRC Maternal and Infant Health Strategies Research Unit, Department of
Obstetrics and Gynaecology, Kalafong Hospital and University of Pretoria,
South Africa.
To compare labour outcomes using aggressive or expectant
management protocols. Randomised trial. Pretoria Academic
Complex, South Africa. It serves an indigent urban population. POPULATION:
Healthy nulliparous women in active labour, at term, with a health singleton
pregnancy and cephalic presentation. The women were randomised to
either aggressive (n = 344) or expectant (n = 350) management protocols.
Aggressive management entailed using a single line partogram, a vaginal
examination every two hours and use of an oxytocin infusion if the line was
crossed. Expectant management entailed using a two line partogram, with the
alert line and a parallel action line four hours to the right, with a
vaginal examination every four hours. If the action line was reached,
oxytocin was started. The women were reassessed every two hours thereafter.
Analgesia was prescribed on request.Objectives:
Design:
Setting:
Methods:
Main Outcome Measures:
Mode of birth,
use of oxytocin and analgesia and neonatal outcome.
Results:
The groups were
similar with respect to maternal age, cervical dilation at trial entry,
number crossing the alert line and birthweight of the infants. Significantly
fewer women managed aggressively had caesarean sections (16.0%) than those
managed expectantly (23.4%) (relative risk [RR] 0.68, 95% confidence
intervals [CI] 0.50, 0.93). Significantly more oxytocin was used in the
aggressive management group, but there was no difference with respect to the
use of analgesia or episiotomy or in neonatal outcome with respect to the
Apgar score at 1 or 10 minutes. There were three perinatal deaths. One woman
was found to have an intrauterine death before trial entry and the other two
were in the aggressive management group but did not receive oxytocin.
Compliance by staff was poor in the aggressive management group.
Conclusions:
Aggressive management of labour reduces the caesarean section rate in nulliparous women but requires more intensive nursing.
Your Own Web Presence
For £35
Have your own web ad on the internet and optimized for good positioning.
Your Own Dedicated Web Page Designed Specifically For You
More Effective
Than Your Own
Single Page Website
For £35