Active management of labour revisited

Impey, Lawrence; Boylan, Peter

doi:10.1111/j.1471-0528.1999.tb08229.x

Cited by 29 publications

(13 citation statements)

References 39 publications

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“…Thus the mode of delivery should be made after carefully presenting balanced information about the risks and benefits in relation to vaginal and abdominal deliveries. If the intention about well‐informed patients should be substantial, labor ward units must address more attention to record and present their data concerning maternal outcomes (18). In addition, this will give each labor unit the possibility of evaluating and, if necessary, improving obstetric management to increase maternal and fetal care.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative surgical complication during cesarean section: an observational study of the incidence and risk factors

Bergholt

Stenderup

Vedsted-Jakobsen

et al. 2003

Acta Obstet Gynecol Scand

108

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Section: Discussionmentioning

confidence: 99%

Intraoperative surgical complication during cesarean section: an observational study of the incidence and risk factors

Bergholt

Stenderup

Vedsted-Jakobsen

et al. 2003

Acta Obstet Gynecol Scand

108

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“…In this unit labour in nulliparous women is actively managed 4 ; multiparous women also undergo routine early amniotomy. Women were recruited immediately after amniotomy and randomised either to a 20-minute admission cardiotocograph or no cardiotocograph.…”

Section: Methodsmentioning

confidence: 99%

Fever in labour and neonatal encephalopathy: a prospective cohort study

Impey

Greenwood

MacQuillan

et al. 2001

BJOG

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Objective To determine whether the reported association of maternal fever with neonatal encephalopathy is independent of other associated intrapartum risk factors.Design Prospective cohort study.Setting Dublin teaching hospital delivery ward. Population 4915 low risk women in labour at 36-41 weeks of gestation.Methods Using logistic regression with odds ratios and 95% con®dence intervals, the incidence of neonatal encephalopathy and other neonatal outcomes of women who had an intrapartum fever .37.58 C was compared with those who did not.Results The cohort comprised 33% of all deliveries during the study period. Neonatal encephalopathy was diagnosed in 3.25/1000 births. The incidence of intrapartum fever was 6.8%. Maternal fever was strongly associated with neonatal encephalopathy (crude OR 10.8, 95% CI 4.0-29.3). Univariate analysis showed maternal fever was associated with epidural analgesia, nulliparity, induction, longer labour, oxytocin administration, greater fetal birthweight and gestational age and instrumental vaginal delivery, but not with prolonged (.24hours) prelabour rupture of the membranes. The association of fever with neonatal encephalopathy persisted having adjusting for these covariates (adjusted OR 4.72, 95% CI 1.28-17.4). Conclusions The relationship between maternal intrapartum fever and neonatal encephalopathy is independent of other known intrapartum risk factors. This provides further evidence for the role of in¯ammatory processes in the aetiology of neonatal neurological morbidity.

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“…For women at low risk of complications, it marks the transition from midwifery to obstetric management. Since proponents of active management first claimed the benefits of shorter labour and lower rates of caesarean section,2 3 debate has continued over conservative versus aggressive management and the medicalisation of birth. Management strategies for dystocia vary from immediate augmentation4 5 to delayed intervention up to four hours after diagnosis 6 – 8.…”

Section: Introductionmentioning

confidence: 99%

Randomised controlled trial of labouring in water compared with standard of augmentation for management of dystocia in first stage of labour

Cluett

Pickering

Getliffe

et al. 2004

BMJ

113

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Objectives To evaluate the impact of labouring in water during first stage of labour on rates of epidural analgesia and operative delivery in nulliparous women with dystocia. Design Randomised controlled trial. Setting University teaching hospital in southern England. Participants 99 nulliparous women with dystocia (cervical dilation rate < 1 cm/hour in active labour) at low risk of complications. Interventions Immersion in water in birth pool or standard augmentation for dystocia (amniotomy and intravenous oxytocin). Main outcome measures Primary: epidural analgesia and operative delivery rates. Secondary: augmentation rates with amniotomy and oxytocin, length of labour, maternal and neonatal morbidity including infections, maternal pain score, and maternal satisfaction with care. Results Women randomised to immersion in water had a lower rate of epidural analgesia than women allocated to augmentation (47% v 66%, relative risk 0.71 (95% confidence interval 0.49 to 1.01), number needed to treat for benefit (NNT) 5). They showed no difference in rates of operative delivery (49% v 50%, 0.98 (0.65 to 1.47), NNT 98), but significantly fewer received augmentation (71% v 96%, 0.74 (0.59 to 0.88), NNT 4) or any form of obstetric intervention (amniotomy, oxytocin, epidural, or operative delivery) (80% v 98%, 0.81 (0.67 to 0.92), NNT 5). More neonates of women in the water group were admitted to the neonatal unit (6 v 0, P = 0.013), but there was no difference in Apgar score, infection rates, or umbilical cord pH. Conclusions Labouring in water under midwifery care may be an option for slow progress in labour, reducing the need for obstetric intervention, and offering an alternative pain management strategy.

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Active management of labour revisited

Cited by 29 publications

References 39 publications

Intraoperative surgical complication during cesarean section: an observational study of the incidence and risk factors

Intraoperative surgical complication during cesarean section: an observational study of the incidence and risk factors

Fever in labour and neonatal encephalopathy: a prospective cohort study

Randomised controlled trial of labouring in water compared with standard of augmentation for management of dystocia in first stage of labour

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