Use Of Syntocinon Research Articles

Breech presentation and moxibustion: should it be offered to improve maternal outcomes?

Background It is known that moxibustion promotes cephalic version, thereby increasing the likelihood of vaginal birth, reducing the chances of a caesarean section and augmentation in labour. This study aimed to review and critically appraise research articles on the benefits of moxibustion use for low-risk women with breech presentation. Methods This study reviewed research articles published in English between July 2010 and July 2020. A computerised search using Maternity and Infant Care, CINAHL Complete, Cochrane Database of Systematic Reviews and Medline databases was undertaken, using a combination of terms such as ‘moxibustion’, ‘childbirth’, ‘birth’, ‘labour’ and ‘labor’. One article was chosen after reading the references of the articles selected. Overall five research articles were analysed using specific critique guidelines. Results The studies confirmed the use of moxibustion to turn a breech fetus, and found that in combination with acupuncture, moxibustion decreases the rate of caesarean section syntocinon use before and during labour for women who had a vaginal birth, as well as slightly decreasing instrumental use at birth. Moxibustion was safe and well accepted by women. However, studies need to be interpreted with caution because of clinical and statistical heterogeneity, and further quality evidence is required. Conclusions Moxibustion use for women with uncomplicated pregnancies may reduce the number of breech presentations at birth, caesarean section rates, syntocinon use and instrumental births.

Comparison of labour and birth outcomes between nulliparous women who used epidural analgesia in labour and those who did not: A prospective cohort study

ObjectiveTo compare labour and birth outcomes between nulliparous women who used versus did not use intrapartum epidural analgesia. DesignProspective cohort study. SettingTwo maternity hospitals in Ireland. PopulationA total of 1221 nulliparous women who gave birth vaginally or by emergency caesarean section. MethodsMultinomial logistic regression was used to analyse categorical outcomes, with results presented as ratios of relative risks (RRR). For dichotomous outcomes we used logistic regression, with results presented as odds ratios (OR). Main outcome measuresMode of birth, IV syntocinon use, pyrexia (≥38°C), antibiotic treatment, first stage labour ≥10h, second stage labour ≥2h, blood loss (≥500mls, ≥1000mls), perineal trauma. Neonatal outcomes included Apgar score ≥7 at 1min and 5min, admission to neonatal intensive care unit, and infant feeding method. ResultsWomen using EA were more likely to require a vacuum-assisted birth (RRR 3.35, p<0.01) or forceps-assisted birth (RRR 11.69, p<0.01). Exposure to EA was associated with significantly greater risk of ≥10h first (OR 6.72, p=0.01) and ≥2h second (OR 2.25, p<0.01) stage labour, increased likelihood of receiving IV syntocinon (OR 9.38, p<0.01), antibiotics (OR 2.97, p<0.01) and a greater probability of pyrexia (OR 10.26, p<0.01). Women who used EA were half as likely to be breastfeeding at three months postpartum (OR 0.53, p<0.01). No differences were observed between groups in neonatal outcomes. ConclusionsOur data shows significant associations between EA use and several intrapartum outcomes.

Comparison of different methods of measuring angle of progression in prediction of labor outcome

First, to compare the manual sagittal and parasagittal and automated parasagittal methods of measuring the angle of progression (AoP) by transperineal ultrasound during labor, and, second, to develop models for the prediction of time to delivery and need for Cesarean section (CS) for failure to progress (FTP) in a population of patients undergoing induction of labor. This was a prospective observational study of transperineal ultrasound in a cohort of 512 women with a singleton pregnancy undergoing induction of labor. A random selection of 50 stored images was assessed for inter- and intraobserver reliability of AoP measurements using the manual sagittal and parasagittal and automated parasagittal methods. In cases of vaginal delivery, univariate linear, multiple linear and quantile regression analyses were performed to predict time to delivery. Univariate and multivariate binomial logistic regression analyses were performed to predict CS for FTP in the first stage of labor. The intraclass correlation coefficient (ICC) for the manual parasagittal method for a single observer was 0.97 (95% CI, 0.95-0.98) and for two observers it was 0.96 (95% CI, 0.93-0.98), indicating good reliability. The ICC for the sagittal method for a single observer was 0.93 (95% CI, 0.88-0.96) and for two observers it was 0.74 (95% CI, 0.58-0.84), indicating moderate reliability for a single observer and poor reliability between two observers. Bland-Altman analysis demonstrated narrower limits of agreement for the manual parasagittal approach than for the sagittal approach for both a single and two observers. The automated parasagittal method failed to capture an image in 19% of cases. The mean difference in AoP measurements between the sagittal and manual parasagittal methods was 11°. In pregnancies resulting in vaginal delivery, 54% of the variation in time to delivery was explained in a model combining parity, epidural and syntocinon use during labor and the sonographic findings of fetal head position and AoP. In the prediction of CS for FTP in the first stage of labor, a model which combined maternal factors with the sonographic measurements of AoP and estimated fetal weight was superior to one utilizing maternal factors alone (area under the receiver-operating-characteristics curve, 0.80 vs 0.76). First, the method of measuring AoP with the greatest reliability is the manual parasagittal technique and future research should focus on this technique. Second, over half of the variation in time to vaginal delivery can be explained by a model that combines maternal factors, pregnancy characteristics and ultrasound findings. Third, the ability of AoP to provide clinically useful prediction of CS for FTP in the first stage of labor is limited. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Identifying the risk: a prospective cohort study examining postpartum haemorrhage in a regional Australian health service

BackgroundIn industrialised countries the incidence of postpartum haemorrhage (PPH) is increasing, for which exact etiology is not well understood. Studies have relied upon retrospective data with estimated blood loss as the primary outcome, known to be underestimated by clinicians. This study aimed to explore variables associated with PPH in a cohort of women birthing vaginally in coastal Queensland, Australia, using the gravimetric method to measure blood loss.MethodsWomen were prospectively recruited to participate using an opt-out consent process. Maternal demographics; pregnancy history; model of care; mode of birth; third stage management practices; antenatal, intrapartum and immediate postpartum complications; gravimetric and estimated blood loss; and haematological laboratory data, were collected via a pre-designed data collection instrument. Descriptive statistics were used for demographic, intrapartum and birthing practices. A General Linear Model was used for multivariate analysis to examine relationship between gravimetric blood loss and demographic, birthing practices and intrapartum variables. The primary outcome was a postpartum haemorrhage (blood loss > 500 ml).Results522 singleton births were included in the analysis. Maternal mean age was 29 years; 58% were multiparous. Most participants received active (291, 55.7%) or modified active management of third stage (191, 36.6%). Of 451 births with valid gravimetric blood loss recorded, 35% (n = 159) recorded a loss of 500 ml or more and 111 (70%) of these were recorded as PPH. Gravimetric blood loss was strongly correlated with estimated blood loss (r = 0.88; p < 0.001). On average, the estimated blood loss was lower than the gravimetric blood loss, about 78% of the measured value. High neonatal weight, perineal injury, complications during labour, separation of mother and baby, and observation of a gush of blood were associated with PPH. Nulliparity, labour induction and augmentation, syntocinon use were not associated with PPH.ConclusionsIn contrast to previous study findings, nulliparity, labour induction and augmentation were not associated with PPH. Estimation of blood loss was relatively accurate in comparison to gravimetric assessment; raising questions about routine gravimetric assessment of blood loss following uncomplicated births. Further research is required to investigate type and speed of blood loss associated with PPH.

Labour and beyond: The roles of synthetic and endogenous oxytocin in transition to motherhood

During spontaneous labour, endogenous oxytocin is released from the pituitary gland and initiates uterine contractions. In some women, it is necessary to induce or augment labour contractions. Induction or augmentation of labour using synthetic oxytocin (Syntocinon) is one of the most common interventions to facilitate the progress of labour and birth. Both Syntocinon and endogenous oxytocin affect the body through oxytocin receptors. Although the use of Syntocinon is regarded as a relatively safe intervention during labour, it works in a different way from endogenous oxytocin and has different effects on the mother and child. Syntocinon may negatively affect birth outcomes for mother and baby, interfere with the success of lactation and breastfeeding, impair the mother-child attachment and may affect the child's development. We review the effect of endogenous oxytocin and Syntocinon on the health and wellbeing of women during labour and after birth, discuss the benefits of endogenous oxytocin and highlight some adverse effects of Syntocinon.

How to reduce synthetic oxytocin administration and stimulate the production of endogenous oxytocin in childbirth

The purpose of this review is to examine synthetic and natural oxytocin use in pregnancy and post-partum. We distinguished synthetic oxytocin (Syntocinon®) use in labor as a uterine contraction stimulant in two parts: the first is for induction or augmentation of labor; the second for prevention of post-partum hemorrhage (PPH).Oxytocin, key hormone in the process of childbirth and lactation, is a strong smooth muscle stimulant. For this reason it is widely used to induce/augment labor and to prevent and cure PPH.However, Syntocinon® can penetrate the placenta and reach fetal circulation, thus causing various systemic effects on mother and fetus. Oxytocin plays an important role as a neurotransmitter in the central nervous system, affecting numerous neuro-behavioral functions and it is involved in many types of parental behavior in humans and animals. It is, in fact, involved in a wide variety of physiological and pathological functions such as sexual activity, penile erection, ejaculation, pregnancy, uterus contractions, milk ejection, maternal behavior, social bonding, and stress. Oxytocin has a decisive role in the process of “bonding” between mother and child and in that of social affiliation.We therefore explored the opportunity to reduce the use of Syntocinon® in labor ward as a precautionary measure.Finally, we place the emphasis on some techniques that will probably increase the production of endogenous oxytocin. Proceedings of the 11th International Workshop on Neonatology and Satellite Meetings · Cagliari (Italy) · October 26th-31st, 2015 · From the womb to the adultGuest Editors: Vassilios Fanos (Cagliari, Italy), Michele Mussap (Genoa, Italy), Antonio Del Vecchio (Bari, Italy), Bo Sun (Shanghai, China), Dorret I. Boomsma (Amsterdam, the Netherlands), Gavino Faa (Cagliari, Italy), Antonio Giordano (Philadelphia, USA)

UTERINE RUPTURE

Objective: To determine frequency and to identify social, demographic andobstetrical causes of rupture uterus in Bagh Azad Jamu Kashmir and to define appropriaterecommendations for its prevention and effective management. Study Design: A descriptivecase series study. Setting: DHQ Hospital Bagh at AJK. Period: 1st September 2008 to 30thSeptember 2012 was done. Methodology: Data was entered on pre-design proforma includedage, parity, booked or un-booked cases, time delay to reach hospital and etiological factors.Results: Incidence of rupture uterus is 1:185 deliveries. Mostly occurred in grand multipara andinjudious use of syntocinon and neglected labor are most common cause. Conclusions: Skilledbirth attendant, free transportation and avoidance of undue use of syntocinon in peripheralhealth center are key element for better maternal outcome.

Cerebral palsy: intrapartum causal criteria used in courts.

In spite of advances in obstetrics and neonatology, the reported incidence of cerebral palsy in developed countries is about two per 1000 live births (Graham et al. Am J Obstet Gynecol 2008;199:587–95). The linked paper by Leigh et al. suggests that almost one in seven cases are the result of intrapartum hypoxia, and the UK Confidential Enquiry into Stillbirths and Deaths in Infancy (1999) found that 50% of 567 of such cases investigated were possibly or probably preventable. In the UK, during 2000–2010, awards for cerebral palsy judged preventable by better care totalled £1 263 581 324: 41% of all obstetric settlements (Ten Years of Maternity Claims. NHS Litigation Authority, 2012). In the case of McKenzie vs Fife Acute Hospitals NHS Trust [2006] ScotCS_63, the judgment included a ‘threefold test’ for duty of care. The harm must be: (a) reasonably foreseeable; (b) there must be a ‘relationship of proximity’ (duty of care) between the plaintiff/claimant and the defendant; and (c) it must be ‘fair, just and reasonable’ to impose liability. Evidence from the International Cerebral Palsy Task Force (MacLennan BMJ 1999;319:154–9) was used to support a causal relationship between acute intrapartum hypoxia and cerebral palsy. The case met all of the three essential criteria: (a) intrapartum metabolic acidosis (pH < 7.00 and base deficit ≥12 mmol/l); (b) early onset severe or moderate neonatal encephalopathy at ≥34 weeks of gestation; and (c) subtype spastic quadriplegia or dyskinetic cerebral palsy. The case also met four of the five non-specific criteria: (a) sudden, rapid, and sustained deterioration of the fetal heart rate; (b) APGAR score of 0–6 for >5 minutes; (c) early multisystemic dysfunction; and (d) early imaging evidence of acute cerebral abnormality. Only one criterion was difficult to establish: evidence of an identified sentinel hypoxic event, such as (a) listed above. The plaintiff's lawyers successfully argued that the prolonged use of Syntocinon®, compounded by misinterpretation of the cardiotocogram, was sufficient to cause damaging hypoxia, however. The judge was satisfied that, on the balance of probabilities, there was an act of omission, as had steps been taken earlier to discontinue the Syntocinon® infusion and expedite delivery the damage would have been avoided. There was a failure to exercise the due diligence that was expected from a reasonably prudent and skilled professional. A similar finding was reached in the more recent case of Jack Clayton vs Yeovil District Hospital (http://www.dailymail.co.uk/health/article-2218209/Oxytocin-How-drug-used-speed-births-starve-baby-oxygen.html), highlighting the medico-legal cost of using a powerful drug without due diligence. Obstetricians and midwives must remember that although many cases of cerebral palsy have genetic, environmental, and antenatal causes, this does not obviate their duty to avoid substandard care that will result in them being held responsible for damaging intrapartum hypoxia. None to declare.

Caesarean section audit spiral spanning 6 years of management in 3 major obstetric units of Glasgow

BackgroundCaesarean section(CS) rates in Scotland have increased from 8.6% in 1976 to 25.4% in 2010.1Aims & ObjectivesIn this study, we appraised the management of caesarean section against NICE and local...

Are low arterial phs at delivery associated with syntocinon use?

Syntocinon is used with increasing frequency on labour wards. Reports suggest that the misuse of syntocinon is associated with increasing labour complications such as uterine hypertonicity and fetal heart rate...

Induction of labour with vaginal prostaglandin tablet vs gel

The objective of this study was to compare outcomes in women whose labour was induced with vaginal prostaglandin E2 tablets with those induced with prostaglandin gel. We compared outcomes of induction during two audits conducted in 2005 (PGE2 gel) and 2009 (PGE2 tablets). We found that there was no difference in induction rates; 21% in 2005 and 24% in 2009. The recommended dose of prostaglandin E2 was exceeded in 6% and 17% of women induced with gel and tablets, respectively (p = 0.007). There was a difference in use of syntocinon to augment uterine contractions, 39% vs 58% for women induced with gel and tablets, respectively (p = 0.001). There was no difference in overall operative delivery, 37% in gel and 38% in tablets. There was no difference in the proportion of women who had vaginal birth within 24 h; 50% vs 42% for gel and tablet, respectively (p = 0.187). We conclude that compared to prostaglandin gel, women who received prostaglandin tablets were more likely to require syntocinon to augment contractions.

Retrospective study assessing impact of changes in ‘management of normal labour’ guidelines

BackgroundOur hospital guidelines were updated following the publication of the National Institute for Health and Clinical Excellence guidelines on intrapartum care.The most significant differences were the change from 3 hourly...

Effects of Syntocinon use in active management of third stage labour

Following the publication of guidance from the National Institute for Health and Clinical Excellence (NICE) (2007) , Syntometrine was withdrawn in practice for routine use as part of the active management of the third stage and replaced with Syntocinon 10 international units (iu). While it was recognized that these guidelines related to the care of low-risk women, from the evidence reviewed there did not appear to be any reason not to recommend the use of Syntocinon for the majority of women. Concern about perceived increase in major postpartum haemorrhage (&gt;100 ml) resulted in a retrospective comparative study of primary postpartum haemorrhage (PPH) rates and blood transfusion rates. This study found a statistically significant increase in estimated blood loss (EBL) above 1000 ml from 2008 to 2010 (0.59% vs. 1.74%). Nevertheless, there was no statistically significant increase in blood transfusion rates. Possible reasons for this increase are suggested, including: the limitations of the present study compared to previous studies; the experience of staff using Syntocinon 10iu; as well as the attitude of staff toward this practice change. In view of these issues, the researchers do not believe that these results provide robust evidence to revert to using Syntometrine, contrary to the recommendations of the Centre for Maternal and Child Enquiries (CMACE) (2011) .

Comparison of two policies for induction of labour postdates

The objective of this study was to compare maternal and midwifery manpower effects of policies for induction of labour (IOL) postdates, using a retrospective cohort design, in a level two maternity unit in a district hospital in South-West England. Primary outcome measures included mode of delivery, admission–delivery interval, midwifery manpower use. Group I consisted of 124 women who underwent IOL at 40+10. Group II were 104 women who underwent IOL at 42 weeks' gestation and 123 women who laboured spontaneously between 40+10 and 42 weeks' gestation. The nulliparous women had a shorter admission–delivery interval when induction was planned for 42 weeks, compared with 40+10 (p = 0.003), and required less frequent use of syntocinon (p = 0.04) and of continuous fetal monitoring (p = 0.02). The caesarean rate was higher in Group I than in Group II (p = 0.04) for nulliparous women only. The earlier induction policy was associated with a higher midwifery manpower requirement for nulliparae (p = 0.002). For parous women, the only difference was the greater use of oxytocin in labour. There was no difference between the groups in duration of labour, analgesia, Apgar scores, admission to neonatal care and meconium aspiration. In conclusion, delaying planned induction by three days was associated with lower medicalisation of labour and manpower needs for nulliparous women.

IV paracetamol vs other opiates and analgesics

IntroductionA trial of the use of intravenous Paracetamol in high dependency labouring women at JCUH was undertaken to assess the need for additional pain relief and delivery and neonatal outcome.MethodsWomen...

Maternal and neonatal risk factors for childhood type 1 diabetes: a matched case-control study

BackgroundAn interaction between genetic susceptibility and environmental factors is thought to be involved in the aetiology of type 1 diabetes. The aim of this study was to investigate maternal and neonatal risk factors for type 1 diabetes in children under 15 years old in Grampian, Scotland.MethodsA matched case-control study was conducted by record linkage. Cases (n = 361) were children born in Aberdeen Maternity Hospital from 1972 to 2002, inclusive, who developed type 1 diabetes, identified from the Scottish Study Group for the Care of Diabetes in the Young Register. Controls (n = 1083) were randomly selected from the Aberdeen Maternity Neonatal Databank, matched by year of birth. Exposure data were obtained from the Aberdeen Maternity Neonatal Databank. Conditional logistic regression was used to evaluate the association between various maternal and neonatal factors and the risk of type 1 diabetes.ResultsThere was no evidence of statistically significant associations between type 1 diabetes and maternal age, maternal body mass index, previous abortions, pre-eclampsia, amniocentesis, maternal deprivation, use of syntocinon, mode of delivery, antepartum haemorrhage, baby's sex, gestational age at birth, birth order, birth weight, jaundice, phototherapy, breast feeding, admission to neonatal unit and Apgar score (P > 0.05). A significantly decreased risk of type 1 diabetes was observed in children whose mothers smoked at the booking appointment compared to those whose mothers did not, with an adjusted OR of 0.67, 95% CI (0.46, 0.99).ConclusionsThis case-control study found limited evidence of a reduced risk of the development of type 1 diabetes in children whose mothers smoked, compared to children whose mothers did not. No evidence was found of a significant association between other maternal and neonatal factors and childhood type 1 diabetes.

Frequency of uterine rupture at delivery and accompanying risks for the mother and the newborn

Uterine rupture at delivery is a severe lifethreatening complication for both mather and the newborn. The aim of the study was to determine the frequency of total number uterine rupture within the deliveries, to perceive circumstances and causes that lead to rupture, to establish perinatal and maternal mortality and to present our therapeutic procedure. In the group of 37 ruptures at 59 660 deliveries from the period 1991-2000 included in this retrospective study we analyzed age, level of education, gestational age, parity, previous caesarian section and other operations on uterus, time of diagnosing rupture, grade and place of rupture, use of Syntocinon and Prostaglandin at delivery, perinatal and maternal mortality, as well as therapeutic procedures at rupture that occurred. The highest influence on uterine rupture in our group had been exerted by previous caesarian section and myomectomy in relation 33 : 4. Incomplete uterine ruptures were more frequent, 26 (70.27%), in relation to complete ones, 11 (29.75%). The most frequent place of uterine rupture was the front wall, 34 (91.89%), two ruptures occurred on the fundus and one on the back wall. The most frequently applied therapeutic procedures were rupture suture in 31 (83.78%) cases, and in six (16.22%) cases hysterectomy. Perinatal mortality was three times higher than average (17.78%) in that period and was 51.28%. We emphasize that rupture frequency in the total number of deliveries was one rupture at 1 612 deliveries, whereas rupture frequency on the intact uterus was 1 : 17 269, and frequency of uterine rupture after caesarian section was one rupture at 245 deliveries. Our research as well as researches of other authors, showed that a previous caesarian section is the most frequent cause for the occurrence of uterine rupture. Therefore, caesarian section should be avoided whenever possible, not just because of a potential rupture, but also because of more frequent hysterectomy that interrupts woman's reproductive ability.

Labour ward incidents and potential claims – lessons learned from research

This paper provides an insight into the underlying factors involved in potential cerebral palsy and/or shoulder dystocia claims. The research was undertaken to identify the root causes of 37 cases of birth asphyxia in term infants severe enough to warrant admission to neonatal care units in the north-west of England between 2001 and 2002. All available staff ( n = 93) providing care during critical periods were interviewed by the author using the cognitive interviewing technique. These included 81 midwives, two consultant obstetricians, eight registrars and two senior house officers. An expert panel consisting of consultant obstetricians, midwives, a consultant neonatologist and the researcher applied the Bolam test to identify instances where care had been substandard and injury caused as a result. Although the cases were often complex, covering more than one shift and over more than one stage of labour, the most dangerous time appeared to be during the night shift (19 cases, 51%), followed by the evening shift (13 cases, 35%) and then the day shift (five cases, 14%). The main problems include: failure to respond appropriately to signs of fetal hypoxia (26 cases, 70%); undiagnosed obstruction (22 cases, 59%), which was broken down into failure to identify cephalopelvic disproportion (13 cases, 35%); and shoulder dystocia (nine cases, 24%). Delayed resuscitation of the infant occurred in 26 cases (80%), and in 18 cases (49%) there was excessive and inappropriate use of Syntocinon. All cases involved human error, either through a delay or failure to take action, or taking inappropriate action. However, these were all underpinned and perpetuated by system and cultural errors present in the labour wards, such as allowing unsupported and inexperienced personnel to work in a position for which they lacked the necessary skill and experience. This was perpetuated by the customary practice of using unsupervised junior medical staff in a first on-call position for complications, and also of failing to sustain safe midwifery staffing levels. This in turn prevented support for more inexperienced staff. Consequently, when inexperienced midwives and obstetricians were left unsupervised in charge of complicated cases, it created accidents waiting to happen. When unsupervised and inexperienced paediatricians attended the birth of an asphyxiated infant, the child's condition deteriorated further when they were unable to resuscitate it. If such system and cultural errors as these are not rectified, the current high rate of damaged babies is likely to continue.

Intrapartum pain management at the Royal Hospital for Women.

To explore use of, and women's satisfaction with, intrapartum pain management at Royal Hospital for Women (RHW), Sydney, Australia. From October 2002 to January 2003 women aged over 16 who had been in labour at RHW were given a questionnaire to complete in the first week post-partum regarding their intrapartum pain management. Supplementary information was obtained from patient records. A total of 496 women participated (69% response rate), including 95 birth centre clients. The mean age was 32 years and 73% percent had a normal vaginal delivery. At least one form of pain management ('natural', nitrous oxide, pethidine, epidural, local infiltration of the perineum) was used by 463 (93%) women, with 74% using two or more methods. Labour pain was 'worse' or 'much worse' than expected for 55%. Seventy-two percent were 'very' or 'quite' satisfied with overall pain management. Epidural analgesia had the highest utility scores (89%'very useful') and likelihood of use in subsequent labours (67%), and pethidine the lowest. Factors affecting analgesic use included cervical dilation on admission, labour length, English-speaking background, delivery suite versus birth centre care, parity, and syntocinon use. Women at RHW use a variety of pain management methods in labour and most use multiple methods. Labour was rated more painful than expected by a majority; however, most were satisfied with their pain management. Labour length and cervical dilation on admission were most predictive of pain management use.

The impact of delivery suite guidelines on intrapartum care in ‘standard primigravida’

Objective: To compare intrapartum interventions and outcomes in low-risk primiparous women and identify factors which may contribute to the variations between different maternity units. Design: Prospective observational study. Participants: Ten maternity units in England. Methods: Participating units provided data on 11 clinical indicators for all ‘standard primigravidae’ delivered between January and December 2000 and provided information on written delivery suite policies operational during July 2000. Results: There was a significant inter-unit variation in the use of intrapartum foetal blood sampling, use of syntocinon for augmentation of labour, mode of delivery, type of perineal damage, postpartum haemorrhage, low Apgar score and admission to SCBU. Units with guidelines for intrapartum foetal heart monitoring had higher rate of normal vaginal deliveries (odds ratio (OR): 1.34; 99% confidence interval (CI): 1.05–1.70) and lower rate of Caesarean section for foetal distress (OR: 0.57; 99% CI: 0.34–0.96). Units with partogram guidelines also had lower rates of Caesarean section for foetal distress (OR: 0.49; 99% CI: 0.30–0.81). Units with guidelines on the management of episiotomy had higher episiotomy rates (OR: 1.54; 99% CI: 1.15–2.06) while units with guidelines on the involvement of neonatal staff recorded less babies with Apgar score <7 at 5 min (OR: 0.37; 99% CI: 0.17–0.76). Conclusions: Written delivery suite guidelines have significant impact on the type of intrapartum care and outcome of pregnancy in low-risk women. Their availability suggests more active role of interested clinicians in the provision of intrapartum care. There is an urgent need to identify other factors that influence quality and quantity of clinical input into the care of low-risk pregnant women.