Active Management of Labour and Cephalopelvic Disproportion

Abstract

Summary A preoccupation with cephalopelvic disproportion is the main reason for a reluctance to abandon the conservative attitude towards labour which prevails in the United Kingdom and Ireland. In a series of 1000 consecutive primigravidae, in which an active approach to labour was adopted, the incidence of disproportion was less than 1 per cent and there was notable absence of trauma, especially to the child. Oxytocin stimulation is recommended as an essential instrument to define disproportion when the natural forces are not adequate. Excessive caution is criticized because a diagnosis of disproportion cannot be made unless uterine action is adequate. It is concluded that the possibility of cephalopelvic disproportion does not justify a passive attitude towards labour in a modern maternity unit.

Obstetric care in low-resource settings: What, who, and how to overcome challenges to scale up?

“…Active management involves strict criteria for the diagnosis of labor, early amniotomy, early oxytocin (with high-dose oxytocin in case of inefficient uterine action), and continuous intrapartum professional support (see item 4.4) [46,47]. A Cochrane review of active management to prevent slow labor among women in spontaneous labor reported a slightly reduced risk of cesarean delivery in the actively managed group (RR 0.88; 95% CI, 0.77-0.99, risk difference 1.47%, NNT = 68) and modestly reduced time from admission to birth (mean difference 1.1 hr; 95% CI, 0.41-1.82 hrs) [48].…”

Comparison of intravenous oxytocin and prostaglandin E2 for accelerating labour.

“…The latter were selected from a series of patients whose labour required acceleration immediately after the completion of the intravenous PGE2 study. [2][3][4][5] Htg/min; for oxytocin the infusion rate was 2-64 mU/min. Conventional parenteral analgesia was administered as required, and no patient was given epidural analgesia.…”

Pharmacological Studies with Lincomycin in Late Pregnancy

“…Improved aseptic techniques and the active management of labour, as advocated by O'Driscoll et al (1969O'Driscoll et al ( , 1970, have helped almost to eliminate the problem of intrauterine infection during labour. Occasional cases still occur, especially after premature rupture of the membranes.…”