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.


METHODS
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.
Rogers
R
R
Department of Obstetrics and Gynecology, University of New Mexico Health Sciences Center, Albuquerque, USA.
Gilson
G J
GJ
Miller
A C
AC
Izquierdo
L E
LE
Curet
L B
LB
Qualls
C R
CR
D000293:Adolescent; D000328:Adult; D000650:Amnion / Q000601:surgery; D000767:Anesthesia, Epidural / Q000009:adverse effects; D016022:Case-Control Studies; D002585:Cesarean Section / Q000706:statistics & numerical data / Q000639:trends; D004305:Dose-Response Relationship, Drug; D005260:Female; D005323:Fetal Monitoring / Q000592:standards*; D006801:Humans; D007751:Labor, Induced; D007743:Labor, Obstetric / Q000187:drug effects / Q000502:physiology*; D010120:Oxytocics / Q000494:pharmacology; D010121:Oxytocin / Q000494:pharmacology; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D013997:Time Factors; D014481:United States; D014590:Uterine Contraction / Q000187:drug effects / Q000502:physiology
D010120:Oxytocics; D010121:Oxytocin