Effects of algorithm for diagnosis of active labour: cluster randomised trial

Abstract

Objective To compare the effectiveness of an algorithm for diagnosis of active labour in primiparous women with standard care in terms of maternal and neonatal outcomes.Design Cluster randomised trial.Setting Maternity units in Scotland with at least 800 annual births.Participants 4503 women giving birth for the first time, in 14 maternity units. Seven experimental clusters collected data from a baseline sample of 1029 women and a post-implementation sample of 896 women. The seven control clusters had a baseline sample of 1291 women and a post-implementation sample of 1287 women.Intervention Use of an algorithm by midwives to assist their diagnosis of active labour, compared with standard care.Main outcomes Primary outcome: use of oxytocin for augmentation of labour. Secondary outcomes: medical interventions in labour, admission management, and birth outcome.Results No significant difference was found between groups in percentage use of oxytocin for augmentation of labour (experimental minus control, difference=0.3, 95% confidence interval −9.2 to 9.8; P=0.9) or in the use of medical interventions in labour. Women in the algorithm group were more likely to be discharged from the labour suite after their first labour assessment (difference=−19.2, −29.9 to −8.6; P=0.002) and to have more pre-labour admissions (0.29, 0.04 to 0.55; P=0.03).Conclusions Use of an algorithm to assist midwives with the diagnosis of active labour in primiparous women did not result in a reduction in oxytocin use or in medical intervention in spontaneous labour. Significantly more women in the experimental group were discharged home after their first labour ward assessment.Trial registration Current Controlled Trials ISRCTN00522952.

Does Admission in Labour Room During Latent Phase of Labour Versus Active Phase Really Matters in Low Risk Women Presenting at Term? A Cross-Sectional Observational Study

“…The present study shows a higher percentage of women needed oxytocin for augmentation both in group I and group II but difference did not reach statistical significance. Our study found that women who were admitted in their latent phase of labor have increased obstetric interventions compared to those in active phase of labor, the findings which are similar to the previous studies done by Cheyne H. et al [7] and Bailit JL et al [8] . Holmes et al [9] found greater frequencies of use of oxytocin and epidural analgesia by women presenting earlier in labour compared to women in active labour.…”

Complex interventions in midwifery care: Reflections on the design and evaluation of an algorithm for the diagnosis of labour

“…The process of designing and evaluating the algorithm discussed here indicated that the algorithm could be used consistently by midwives, and was valid, acceptable and easy to complete (Cheyne et al, 2008a, b). The trial results indicated that it did have some effect on midwives' judgements; women in the intervention group who were assessed with the aid of the algorithm in the early stages of labour were significantly more likely to be sent home (Cheyne et al, 2008b). However, these women were also likely to return immediately, creating a 'revolving door' effect, with very little impact on subsequent interventions that they may have received.…”

“…More women in the units where midwives were using the algorithm were discharged home following their first visit to the labour ward; however, women quickly returned to the hospital and there was no difference in the overall amount of time that women actually spent in the labour ward. There was no difference in National Health Service (NHS) costs but because women in the experimental group were higher likely to have multiple visits to the labour ward, they incurred higher travel costs as a result of the study intervention (Cheyne et al, 2008b).…”

A reanalysis of cluster randomized trials showed interrupted time-series studies were valuable in health system evaluation

“…The five remaining studies were trials of interventions aimed at improving practices among midwives [21] and primary care physicians [22,23,25,28]. All studies were conducted in highincome countries.…”

“…The four data sets that included five time points in one or both periods were from the studies by Flottorp et al [22], Kerse et al [26], and Cheyne et al [21]. Not surprisingly, the effect estimates based on ITS analyses of such few data points were imprecise (ie, wide 95% CIs, see Fig.…”