Low-risk labor - outcomes after introduction of special guidelines combined with increased awareness of risk category.
OBJECTIVE
To study whether special guidelines for low-risk parturients combined with increased awareness of risk category affect the management of labor.


METHODS
Hospital-based registry study.


METHODS
Two identical birth units in one university hospital in Oslo, Norway.


METHODS
All low-risk parturient women in the years 2001-2009; a total of 28 533 deliveries.


METHODS
From September 2005, a special protocol for management of low-risk labors was introduced in one of the units. Data were obtained from standardized patient records, routinely recorded electronically. Outcomes were extracted for each year, and for the years 2006-2009 the outcomes for the two units were compared. Logistic regression was used to study factors associated with spontaneous vaginal delivery.


METHODS
Delivery method, use of electronic fetal monitoring, use of oxytocin, duration of labor and Apgar score at five minutes.


RESULTS
For nulliparas, the unit with special guidelines had a slightly higher rate of spontaneous vaginal deliveries (76 vs. 72.5%, p=0.006), lower use of oxytocin (48.8 vs. 56.1%, p<0.001) and electronic fetal monitoring (63.8 vs. 69.4%, p<0.001) and longer duration of labor. In multiparas, there was a small difference (15.5 vs. 18.4%, p=0.003) in the use of oxytocin. In a logistic regression, spontaneous vaginal delivery in nulliparas was negatively associated with use of oxytocin and electronic fetal monitoring, but not with the birth unit.


CONCLUSIONS
A special protocol to increase awareness of risk category led to a small, although statistically significant, increase in the rate of spontaneous vaginal delivery in nulliparous, but not in parous low-risk parturients.
Department of Obstetrics, Oslo University Hospital Ulleval, Norway. b.i.nesheim@medisin.uio.no
Britt-Ingjerd
BI
Nesheim
D000328:Adult; D036861:Delivery, Obstetric / Q000379:methods / Q000592:standards*; D005260:Female; D005323:Fetal Monitoring / Q000706:statistics & numerical data; D006801:Humans; D007743:Labor, Obstetric; D016015:Logistic Models; D010120:Oxytocics; D010121:Oxytocin; D036801:Parturition; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D015397:Program Evaluation; D011446:Prospective Studies; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D012042:Registries; D018570:Risk Assessment
D010120:Oxytocics; D010121:Oxytocin