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Active management of labour: current knowledge and research issues

J G Thornton¹, R J Lilford

¹Institute of Epidemiology, University of Leeds.

BMJ (Clinical Research Ed.)

|August 6, 1994

Summary

Continuous professional support during labor can reduce operative delivery rates. However, routine use of early amniotomy and oxytocin is not recommended for reducing cesarean sections or operative vaginal births.

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Area of Science:

Obstetrics and Gynecology
Evidence-Based Medicine
Maternal Health

Background:

Active management of labor, a package of interventions, is proposed to reduce operative delivery rates.
Interventions include strict diagnostic criteria, early amniotomy, early oxytocin, and continuous professional support.

Purpose of the Study:

To review evidence on whether "active management" of labor reduces cesarean sections and operative vaginal deliveries in first labors.
To evaluate the effectiveness of specific components of active labor management.

Main Methods:

Review of observational data.
Inclusion of evidence from four Cochrane Collaboration overviews of randomized trials.

Main Results:

Observational data were inconclusive.
Randomized trials of early amniotomy and early oxytocin did not show reduced rates of cesarean sections or operative vaginal deliveries.
Continuous professional support in labor appears to reduce operative delivery, particularly cesarean sections in specific settings.

Conclusions:

Continuous professional support during labor is recommended.
Routine use of amniotomy and early oxytocin is not advised based on current evidence.

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