Advertisement

Active management of labor: Does it make a difference?

      Abstract

      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.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Flamm BL
        • Quilligan EJ.
        Cesarean section: guidelines for appropriate utilization.
        Springer-Verlag, New York1995
        • O'Driscoll K
        • Jackson R
        • Gallagher JT
        Prevention of prolonged labor.
        BMJ. 1969; 2: 477-481
        • Seitchik J
        • Castillo M.
        Oxytocin augmentation of dysfunctional labor. I. Clinical data.
        Am J Obstet Gynecol. 1982; 144: 899-903
        • American College of Obstetricians and Gynecologists
        Induction and augmentation of labor.
        The College, Washington1991 Jul (Technical Bulletin No.: 157)
        • Thorp JA
        • Boylan PC
        • Parisi VM
        • Heslin EP.
        Effects of high-dose oxytocin augmentation on umbilical cord blood gas values in primigravid women.
        Am J Obstet Gynecol. 1988; 159: 670-675
        • O'Driscoll K
        • Foley M
        • McDonald D
        Active management of labor as an alternative to cesarean sections for dystocia.
        Obstet Gynecol. 1984; 63: 485-490
        • Lopez-Zeno JAS
        • Peaceman AM
        • Adashek JA
        • Socol ML.
        A controlled trial of a program for the active management of labor.
        N Engl J Med. 1992; 326: 450-454
        • Frigoletto FD
        • Lieberman E
        • Lang JM
        • Cohen A
        • Barss V
        • Ringer S
        • et al.
        A clinical trial of active management of labor.
        N Engl J Med. 1995; 333: 745-750
        • Boylan P
        • Frankowski R
        • Rountree R
        • Selwyn B
        • Parrish K.
        The effect of active management of labor on the incidence of cesarean section for dystocia in nulliparae.
        Am J Perinat Med. 1991; 8: 375-380
        • Akoury AH
        • Brodie G
        • Caddick R
        • McLaughin VD
        • Pugh PA.
        Active management of labor and operative delivery in nulliparous women.
        Am J Obstet Gynecol. 1988; 158: 255-259
        • Turner MJ
        • Brassil M
        • Gordon G.
        Active management of labor is associated with a decrease in the cesarean section rate in nulliparae.
        Obstet Gynecol. 1988; 71: 150-153
        • Satin AJ
        • Leveno KJ
        • Sherman ML
        • Brewster DS
        • Cunningham FG.
        High versus low dose oxytocin for labor stimulation.
        Obstet Gynecol. 1992; 80: 11-15
        • Satin AJ
        • Leveno KJ
        • Sherman MC
        • McIntyre DD.
        Factors affecting the dose response to oxytocin for labor stimulation.
        Am J Obstet Gynecol. 1992; 166: 1260-1261
        • Philipsen T
        • Jensen NH.
        Epidural block or parenteral pethidine as analgesic in labor: a randomized study concerning progress in labor and instrumental deliveries.
        Eur J Obstet Gynecol Reprod Biol. 1989; 30: 27-33
        • Thorp JA
        • Hu DH
        • Albin RM
        • McNitt J
        • Meyer BA
        • Cohen GR
        • et al.
        The effect of intrapartum epidural analgesia on nulliparous labor: a randomized controlled prospective trial.
        Am J Obstet Gynecol. 1993; 169: 851-858
        • Chestnut DH
        • Vincent RD
        • McGrath JM
        • Choi WW
        • Bates JN.
        Does early administration of epidural analgesia affect obstetric outcome in nulliparous women who are receiving intravenous oxytocin?.
        Anesthesiology. 1994; 80: 1193-1200
        • Chestnut DH
        • McGrath JM
        • Vincent RD.
        Does early administration of epidural analgesia affect obstetric outcome in nulliparous women who are in spontaneous labor?.
        Anesthesiology. 1994; 80: 1201-1208
        • Ramin SM
        • Gambling DR
        • Lucas MJ.
        Randomized trial of epidural versus intravenous analgesia during labor.
        Obstet Gynecol. 1995; 86: 783-789
        • Friedman EA.
        The graphic analysis of labor.
        Am J Obstet Gynecol. 1954; 68: 1568-1575
        • Barrett JFR
        • Savage J
        • Phillips K
        • Lifford R.
        Randomized trial of amniotomy in labor versus the intention to leave membranes intact until the second stage.
        Br J Obstet Gynaecol. 1992; 99: 5-9
        • Fraser WD
        • Marcoux S
        • Montquin JM
        • Christen A.
        Effect of early amniotomy on the risk of dystocia in nulliparous women.
        N Engl J Med. 1993; 328: 1145-1149
        • The UK Amniotomy Group
        A multicenter randomised trial of amniotomy in spontaneous first labor at term.
        Br J Obstet Gynaecol. 1994; 101: 307-309
        • Sosa R
        • Kennell J
        • Klaus M
        • Robertson S
        • Urrutia J.
        The effect of a supportive companion on perinatal problems, length of labor, and mother-infant interaction.
        N Engl J Med. 1980; 303: 597-600