Comparison of active management of labour versus “traditional” approach

Dr Snehlata Snehlata,Dr Vasudha Sawant,Dr Abhishek Kumar

doi:10.17511/joog.2019.i05.02

Abstract

Background: Management of spontaneous labour is an important issue. Dystocia accounts for increased rate of LSCS. Prolonged labours are associated with higher maternal and neonatal morbidity. With active management, these complications could be reduced. Aims: To study outcome of labour, maternal & perinatal morbidity and mortality with active management of labour. Methods:100 primigravidas, at term were randomly assigned to 2 groups-study group-active management (N = 50) and control group (n=50). Women in active group were managed by early amniotomy and augmentation with Oxytocin at 6mIU/ml. In the control group, women received conservative care, amniotomy after 6cm dilatation and oxytocin at 1mIU/ml. In both groups labour was monitored using modified WHO partogram. Caesarean was done for standard obstetric indications. Results-In active management caesarean rate was 12 percent, as compared with 18 percent in control. Mean length of labour in study group was 5.6 hrs as compared to 7.1 in control group. The 6 percent reduction in the caesarean section rate was primarily due to a decrease in incidence of dystocia. With active management, the average length of labour was shortened by 1.5 hours, because of early amniotomy and oxytocin. No statistical difference was seen in both groups as regards to mortality and morbidity. Conclusions: Active management of labour reduces the incidence of dystocia, decreases duration of labour and increases the rate of vaginal delivery without increasing maternal or neonatal morbidity.

Highlights

Management of spontaneous labour has become an important issue both in the developing and developed world
Status of labor at admission and labor: At hospital admission, the percentage of women whose membranes had ruptured was similar in the two study groups, as was the mean cervical dilatation at first examination (Table 2)
The present study investigated whether the implementation of a protocol for active management of labor would safely lower the rate of caesarean section among nulliparous women

Summary

Introduction

Management of spontaneous labour has become an important issue both in the developing and developed world. The safe motherhood initiative (SMI) emphasizes that the monitoring of labour for early detection of Dystocia is one of the most important approaches for reducing maternal and neonatal mortality and morbidity [2,3]. In this context, the partogram has been adopted by the World Health Organization (WHO) to monitor labour in maternity clinics in developing countries as a simple managerial tool to prevent prolonged labour and its sequelae. Women received conservative care, amniotomy after 6cm dilatation and oxytocin at 1mIU/ml In both groups labour was monitored using modified WHO partogram. Conclusions: Active management of labour reduces the incidence of dystocia, decreases duration of labour and increases the rate of vaginal delivery without increasing maternal or neonatal morbidity

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Results

Discussion

Conclusion