Active management of labour revisited: the first 1000 primiparous labours in 2000

Abstract

This was a prospective observational study in a tertiary referral obstetric unit in Dublin to ascertain the delivery outcome in the first 1000 nulliparous women in 2000. The initial diagnosis of labour was confirmed in the first 1000 consecutive nulliparous women in spontaneous labour with cephalic presentation at term. All patients underwent active management of labour. Active management included strict criteria for the diagnosis of labour, early amniotomy, 2-hourly vaginal examinations, oxytocin augmentation where progress of labour was slow and the presence of a companion (personal nurse) in labour. Epidural analgesia was freely available. Mode of delivery, duration of labour, analgesia usage and maternal and perinatal complications were the main outcome measures. All patients presented with painful uterine contractions, 75% with show in addition, and 36% had spontaneous rupture of membranes on admission. Eighty per cent presented with a cervical dilatation of h 2 cm; 72.2% had epidural for pain relief. In 81.8% of cases electronic fetal monitoring was used to monitor the baby. Oxytocin was used in 51.8% to augment labour and a further 6.4% required its use for the first time in the second stage of labour. Fetal blood sampling was performed in 20.8%. The spontaneous vaginal delivery rate was 71.8%, 4.2% were delivered by caesarean section and the operative vaginal delivery rate was 24%. The incidence of prolonged labour (labour duration >12 hours) was 4.3%. Postpartum haemorrhage occurred in 3.8% of mothers and 1.6% of babies were admitted to the special care baby unit. Our study suggests that active management of labour is associated with a low incidence of prolonged labour and a low caesarean section rate.