[Active management of labor. Preliminary results]

Concerned by the raise in cesarean section rate we introduced a more active management of labor derived from the Dublin experience. This involved a more accurate diagnosis of labor, associated with early diagnosis and augmentation of nonprogressive labor by oxytocin. Two groups of patients who delivered before and after the method was applied were compared. Cesarean section rate fell from 29.6% to 21% (p less than 0.01) and the mean duration of labor was reduced by two hours in nulliparas (from 7 h to 5 h: p less than 0.0005) and by one hour 15 minutes in multiparas (from 4 h 15 min to 3 h: p less than 0.0005), without change in the number of forceps deliveries and the perinatal outcome. Our cesarean section rate remains high. This is largely due to the number of high-risk pregnancies (10% preterm deliveries), the percentage of nulliparas (49%) and the systematic abdominal delivery of breech in nulliparas.