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Active management of labor: is it suitable for a developing country?
B Chanrachakul1, Y Herabutya, P Panburana
1Department of Obstetrics and Gynecology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. rabcr@mahidol.ac.th
Objective:
To evaluate the effectiveness of active management of labor in the setting of a developing country.
Methods:
This historical cohort study compared the labor characteristics and outcome of all anti-HIV positive nulliparous pregnant women (n=96), who delivered between January 1991 and March 1999, treated with traditional labor management to all anti-HIV negative nulliparous pregnant women (n=1856), who delivered in 1998, treated with active management of labor in the tertiary center of a developing country. The year 1998 was chosen by using the total cesarean section rate of nulliparous patients from 1991 to 1998 to find the mean, then selected the year with cesarean section rate nearest to the mean as a control. Data were analyzed by the chi-square and t-tests.
Results:
The length of labor was significantly shortened in the active management group (6.3+/-3.3 h vs. 8.9+/-6 h, P<0.001). A significantly greater proportion of the traditional management group had prolonged labor (29.3% vs. 4.9%, P<0.001). However, the cesarean section rate was not different between the two groups (active vs. traditional=17% vs. 14.6%, P=0.7) with dystocia as a major indication in both groups. Maternal and fetal complications were not different.
Conclusion:
The active management of labor shortened the duration of labor and reduced prolonged labor; however, it did not decrease the cesarean section rate.