Active Management Of Labor Research Articles

Active management of labour

There is still no strong evidence that the 'active management' package of care in labour reduces caesarean section or operative delivery rates. Psychological support has the most evidence of effectiveness, but even this comes largely from poor-quality trials. The evidence that the whole package shortens labour is stronger, but the effect is small in the methodologically stronger studies.

Active management of labor: Does it make a difference?

Objective: Our goal was to evaluate whether active management of labor lowers cesarean section rates, shortens the length of labor, and overcomes any negative effects of epidural analgesia on nulliparous labor. Study design: We randomly assigned 405 low-risk term nulliparous patients to either an active management of labor ( n = 200) or our usual care control protocol ( n = 205). Patients who were undergoing active management of labor were diagnosed as being in labor on the basis of having painful palpable contractions accompanied by 80% cervical effacement, underwent early amniotomy, and were treated with high-dose oxytocin for failure to progress adequately in labor. Results: The cesarean section rate in the active management of labor group was lower than that of controls but not significantly so (active management, 7.5%; controls, 11.7%; p = 0.36). The length of labor in the active management group was shortened by 1.7 hours (from 11.4 to 9.7 hours, p = 0.001). Fifty-five percent of patients received epidural analgesics; a reduction in length of labor persisted despite the use of epidural analgesics (active management 11.2 hours vs control 13.3 hours, p = 0.001). A significantly greater proportion of active management patients were delivered by 12 hours compared with controls (75% vs 58%, p = 0.01); this difference also persisted despite the use of epidural analgesics (66% vs 51%, p = 0.03). Conclusions: Patients undergoing active management had shortened labors and were more likely to be delivered within 12 hours, differences that persisted despite the use of epidural analgesics. There was a trend toward a reduced rate of cesarean section.

Active management of labor: a meta-analysis of cesarean delivery rates for dystocia in nulliparas.

The objective of this article is to determine through meta-analysis of published literature whether active management of labor lowers the cesarean delivery rate for dystocia in nulliparas. Using MEDLINE and reference citations to 1966, 18 published reports in English on active management of labor were identified. Selection criteria for five selected studies included: tenets of active management followed, detailed description of patient selection and analysis, numerical data on cesarean deliveries for dystocia in nulliparas, and use of a control group. Data on cesarean deliveries performed on nulliparas for dystocia were abstracted onto 2 x 2 tables by both authors independently (one blinded to study authors, journal, institution, and conclusions), and quality ratings independently assessed. Differences were resolved by consensus. Individual odds ratios were calculated, with summary odds ratios and 95 percent confidence intervals determined using the Mantel-Haenszel method. Including the three highest quality studies (two randomized, one nonrandomized), there was a 34 percent decrease in cesarean delivery rates associated with active management (OR 0.66, 95 percent CI 0.54-0.81), without an increase in adverse neonatal outcome (OR for cesarean for non-reassuring fetal heart rate monitoring 0.91, 95 percent CI 0.68-1.22). Active management of labor is associated with a 34 percent decrease in the rate of cesarean delivery for dystocia in nulliparas. Along with the expected subsequent decrease in numbers of candidates for trials of labor, the decline in total cesarean deliveries over the entire population directly or indirectly attributable to active management is 13 percent.

Factors associated with rapid labour in nulliparae

The objective of this study was to assess the factors which may influence rapid labour in nulliparae. This is a cohort study of 991 consecutive nulliparae who were admitted in spontaneous labour with a singleton pregnancy and cephalic presentation. The setting was the National Maternity Hospital, Dublin where active management of labour is applied to all nulliparae fitting the above criteria. Rapid labour of 2 hours or less occurred in 82 patients (8.3%). Dilatation of 2 cm of the cervix on admission in labour, gestation of less than 37 weeks, and diminishing birthweight, were more common in rapid labours compared with other labours. Women in rapid labour were not surprisingly less likely to require oxytocin augmentation, or to need operative vaginal delivery or Caesarean section, receive epidural anaesthesia, or attend antenatal classes, compared with other women in labour. Rapid labour was not influenced by the finding that the membranes were already ruptured before admission, the time spent at home with contractions, or social background. Women with rapid labour were more likely to arrive in hospital within 4 hours compared with other women in labour. Rapid labour depends on the efficiency of uterine action which is reflected by the dilatation of the cervix on admission.

The use of intrauterine pressure catheters in active management of labor

The use of intrauterine pressure catheters in active management of labor

Lowering the incidence of cesarean section with active management of labor

Lowering the incidence of cesarean section with active management of labor

Active management of labor: Does it make a difference

Active management of labor: Does it make a difference

Evaluation of a program to introduce active management of labor at a large private hospital

Evaluation of a program to introduce active management of labor at a large private hospital

Prolonged labor in nulliparas: lessons from the active management of labor

To define factors causing prolonged labor in nulliparous women undergoing active management of labor. We included all nulliparas delivered during 1990-1994 with spontaneous onset of labor lasting more than 12 hours, singleton gestation, cephalic presentation, and labor at greater than 37 weeks. Each patient was matched with the next nulliparous woman who delivered with a labor lasting less than 12 hours and who fulfilled the same inclusion criteria. Subjects were managed according to the previously described active management of labor protocol from The National Maternity Hospital, Dublin. In the 5-year period, 9018 nulliparas met inclusion criteria, with 147 (1.6%) having prolonged labor. Prolonged labor was due to inefficient uterine action in 65%, persistent occipitoposterior position in 24%, and cephalopelvic disproportion in 11% of cases. Univariate analysis showed statistically significant (P < .05) differences in maternal body mass index, cervical dilation on admission, oxytocin use, epidural use, placement of epidural at less than 2 cm of dilation, and birth weight between these study groups. On multivariate conditional logistic regression analysis, the following were significant independent predictors for having a prolonged labor (odds ratios with 95% confidence intervals presented): 3.1 (1.3-7.3) for cervical dilation less than 2 cm on admission, 42.7 (7.5-242.0) for early epidural placement, 5.1 (1.9-13.7) for epidural placement at greater than or equal to 2 cm, and 10.2 (3.6-29.4) for birth weight greater than 4000 g. Less-advanced cervical dilation on admission and epidural use, especially when placed early, are strongly associated with prolonged labor.

Active management of labor

Active management of labor was first instituted as a program to shorten the length of nulliparous labor. Numerous institutions have found that implementation of this program decreased rates of cesarean section. Two randomized trials have evaluated this program, with both showing that labor was shortened by approximately 2 hours and maternal infectious morbidity was decreased by approximately 50%. Although one trial demonstrated a significant reduction in the rate of cesarean birth, the other did not. No users have reported any increase in neonatal morbidity. For some institutions implementation of active management of labor principles may be one approach to decrease operative deliveries for dystocia. (Am J Obstet Gynecol 1996;175:363-8.)

A clinical trial of active management of labor: Frigoletto F.D. Jr.; Lieberman E.; Lang J.M.; Cohen A.; Barss V.; Ringer S.; Datta S. USA New Engl J Med 1995 333/12 (745–750)

A clinical trial of active management of labor: Frigoletto F.D. Jr.; Lieberman E.; Lang J.M.; Cohen A.; Barss V.; Ringer S.; Datta S. USA New Engl J Med 1995 333/12 (745–750)

Amniotomy with Oxytocin to Induce and Augment Labour—Be Selective

BJOG: An International Journal of Obstetrics & GynaecologyVolume 103, Issue 4 p. vii-viii Free Access Amniotomy with Oxytocin to Induce and Augment Labour—Be Selective First published: April 1996 https://doi.org/10.1111/j.1471-0528.1996.tb09728.xAboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Amniotomy combined with intravenous oxytocin infusion is a standard method of induction of labour where the cervix is favourable but is sometimes accompanied by problems of oxytocin administration, such as uterine hypertonus and fetal hypoxia. Only three randomised trials have compared a policy of amniotomy alone with amniotomy combined with oxytocin to induce labour; on page 306 of this issue Per Moldin and Gunilla Sundell report the fourth. There were no important differences in outcome with either regimen, and the authors conclude that the woman should have the choice of which method of induction she prefers. Although O'Driscoll and his colleagues introduced the concept of active management of labour nearly thirty years ago, there is still uncertainty concerning the usefulness of this policy, an uncertainty partly resolved by the results of the randomised trial reported by Frigoletto and colleagues last year1. Hendrick Cammu and Eddy van Eeckhout on page 313 describe the results of their trial of active management of labour in which 306 primiparae were randomised to active management or a policy of selective intervention. The strength of Cammu and van Eeckhout's study is that the treatment in the selective intervention group was rigorously defined and was substantially less aggressive than in the women allocated to active management; whereas in Frigoletto's trial, the treatment in the ‘usual care’ group was undefined and consisted of a mixture of regimens, each regimen being the usual practice of the individual participating centres. But the results of the two trials are similar: active management does not offer any advantages over more selective intervention; and the trials, though different in their design, are complementary. The results of the two trials described in this issue do not clearly favour the routine use of oxytocin, either to induce labour where the cervix is favourable, or to augment labour in primiparae in established labour. References 1 Frigoletto FD, Liebeman E, Lang JM et al. A clinical trial of active management of labour. N Engl J Med 1995; 333: 745– 750. CrossrefPubMedWeb of Science®Google Scholar Volume103, Issue4April 1996Pages vii-viii ReferencesRelatedInformation

A Clinical Trial of Active Management of Labor

A Clinical Trial of Active Management of Labor

Active management of labour and caesarean section rates

This article examines active management of labour and its association with reduced rates of caesarean section among primigravidas. It reviews the research evidence cited in support of the wide use of active management of labour, and suggests that alternative methods of ‘managing labour’ may be as effective.

A Clinical Trial of Active Management of Labor

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 randoml...

The determinants of residual bladder volume following spontaneous vaginal delivery

SummarySummaryResidual bladder volumes in 216 women, following spontaneous vertex delivery, were measured by ultrasound. Of these cases, 39 women had asymptomatic residual bladder volumes exceeding 50 ml on the first or second postpartum day. The factors associated with significant residual bladder volume were evaluated using multiple logistic regression analysis. Maternal age. height, parity, gestation, duration of first stage of labour, fetal macrosomia, and the presence or absence of perineal trauma did not contribute significantly to the logistic model. A longer duration of second stage of labour increased the odds of having residual volume > 50 ml (odds ratio = 2–63; 95 per cent confidence interval = 1-19-5-85; P = 0–017) after adjustment for confounding due to intrapartum epidural analgesia. The effect of epidural analgesia was not significant (odds ratio = 1–90; 95 per cent confidence interval = 0-90-4-02; P = 0–092). Avoidance of prolonged maternal pushing during the second stage of labour by active management of labour may result in a reduction in the incidence of significant residual bladder volume postnatally.

A Clinical Trial of Active Management of Labor

A Clinical Trial of Active Management of Labor

Decreased cesarean birth rates and improved perinatal outcome: a seven-year study.

This study examined the decrease in cesarean section rates in relation to perinatal mortality between 1987 and 1993 at the primary referral hospital in north Jordan. Most of the population is at high risk and of low socioeconomic status. The cesarean section rate decreased from 15.5 percent in 1987 to 8.7 percent in 1993, and has remained at this low rate. During the same period the perinatal mortality dropped from 52 to 20.9 deaths per 1000 live births. These results do not include perinatal morbidity. The successful reduction of the cesarean section rate is attributed to active management of labor, trial of labor for women with a previous cesarean birth, and vaginal breech delivery in selected women. We conclude that the rate of cesarean delivery can be safely reduced in a developing country without adverse effects on birth outcomes.

Active Management of Labour

Far more than oxytocin augmentation, active management implies “skillful handling” of labour. Recognizing that a knowledge and awareness of the process of labour will influence a woman’s response to uterine activity and her sense of wellbeing, antenatal instruction is the first component of active management. An accurate diagnosis of labour will avoid creating mis-conceptions on the part of the woman and her family support and will reduce the likelihood of inappropriate intervention for a mistaken diagnosis of dystocia. Active management involves the provision of continuous support, reassurance, and comfort for the woman in labour, and recognizes the benefits of these in promoting the normal progress of labour and in reducing the need for analgesic pharmacology. Maternal and fetal surveillance are necessary to ensure that mother and fetus remain well during labour, but such surveillance is not the sole focus of intrapartum care, and effective fetal surveillance can be achieved best through intermittent fetal heart auscultation. Once in the active phase of labour (cervix fully effaced, 3–4 cm dilated), active management demands that caregivers ensure that continuous progress is made towards full dilatation and delivery. This is achieved through regular pelvic examination. If dystocia occurs once the unusual situation of frank disproportion has been excluded, artificial rupture of the membranes and oxytocin augmentation should be instituted. In the second stage of labour, progress should be continued, an absence of appreciable progress rather than any arbitary time period being an indication for intervention. Such arrested progress may respond to oxytocin augmentation, particularly in the presence of regional analgesia. Maternal expulsive efforts should be withheld until they are likely to be productive, that is once the head has reached the perineum. They may be initiated earlier in a last effort to avoid operative delivery in situations where head descent has ceased in spite of oxytocin augmentation.

Active Management of Labour

Abstract Objectives : To review the evidence that the package of labour interventions collectively called “active management” - namely, strict diagnostic criteria for labour, early amniotomy, early use of oxytocin, and continuous professional support - reduce rates of caesarean sections and operative vaginal delivery in first labours. Design : Review of observational data, supplemented by evidence from four separate overviews of relevant randomised trials previously published as part of the Cochrane Collaboration pregnancy and childbirth database. Results : Observational data do not permit a clear conclusion. There have been no randomised trials of the total package of active management or of the use of strict diagnostic criteria alone, but trials of early amniotomy, early oxytocin, and these interventions combined do not suggest that these interventions are effective in reducing rates of caesarean sections or operative vaginal deliveries. In contrast, the provision of continuous professional support in labour seems to reduce both types of operative delivery, although the effect on caesarean sections is confined to those settings where non-professional companions are not normally present in labour. Conclusions : Delivery units should endeavour to provide continuous professional support in labour, but routine use of amniotomy and early oxytocin is not recommended.