Effects of algorithm for diagnosis of active labour: cluster randomised trial.
OBJECTIVE
To compare the effectiveness of an algorithm for diagnosis of active labour in primiparous women with standard care in terms of maternal and neonatal outcomes.


METHODS
Cluster randomised trial.


METHODS
Maternity units in Scotland with at least 800 annual births.


METHODS
4503 women giving birth for the first time, in 14 maternity units. Seven experimental clusters collected data from a baseline sample of 1029 women and a post-implementation sample of 896 women. The seven control clusters had a baseline sample of 1291 women and a post-implementation sample of 1287 women.


METHODS
Use of an algorithm by midwives to assist their diagnosis of active labour, compared with standard care. Main outcomes Primary outcome: use of oxytocin for augmentation of labour.


RESULTS
medical interventions in labour, admission management, and birth outcome.


RESULTS
No significant difference was found between groups in percentage use of oxytocin for augmentation of labour (experimental minus control, difference=0.3, 95% confidence interval -9.2 to 9.8; P=0.9) or in the use of medical interventions in labour. Women in the algorithm group were more likely to be discharged from the labour suite after their first labour assessment (difference=-19.2, -29.9 to -8.6; P=0.002) and to have more pre-labour admissions (0.29, 0.04 to 0.55; P=0.03).


CONCLUSIONS
Use of an algorithm to assist midwives with the diagnosis of active labour in primiparous women did not result in a reduction in oxytocin use or in medical intervention in spontaneous labour. Significantly more women in the experimental group were discharged home after their first labour ward assessment.


BACKGROUND
Current Controlled Trials ISRCTN00522952.
Cheyne
Helen
H
Nursing Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling FK9 4LA. h.l.cheyne@stir.ac.uk
Hundley
Vanora
V
Dowding
Dawn
D
Bland
J Martin
JM
McNamee
Paul
P
Greer
Ian
I
Styles
Maggie
M
Barnett
Carol A
CA
Scotland
Graham
G
Niven
Catherine
C
D000293:Adolescent; D000328:Adult; D000465:Algorithms; D016000:Cluster Analysis; D005260:Female; D006801:Humans; D007743:Labor, Obstetric / Q000502:physiology*; D009721:Nurse Midwives; D010120:Oxytocics; D010121:Oxytocin; D011247:Pregnancy; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000379:methods*; D011364:Professional Practice; D012606:Scotland; D055815:Young Adult
D010120:Oxytocics; D010121:Oxytocin