Management of Labor
Management of Labor
Management of Labor
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Conclusion Grading Worksheet B – Annotation #66<br />
(<strong>Management</strong> <strong>of</strong> Protracted <strong>Labor</strong>)<br />
Work Group's Conclusion: Active management <strong>of</strong> labor does not reduce the rate <strong>of</strong> Caesarean delivery but may decrease<br />
the length <strong>of</strong> labor and increase patient satisfaction in nulliparas.<br />
Conclusion Grade: II<br />
Authors' Conclusions/<br />
Work Group's Comments (italicized)<br />
Class Qual- Population Studied/Sample Size Primary Outcome Measure(s)/Results (e.g., p-value,<br />
ity<br />
confidence interval, relative risk, odds ratio, likeli-<br />
+,–,ø<br />
hood ratio, number needed to treat)<br />
D – -Delivery statistics for 10-yr pe- -27,780 deliveries in 10 yrs; 3,186 were Caesarean<br />
riod as obtained from birth log- -Risk factors for Caesarean stable throughout study<br />
book; prior to data collection period (% <strong>of</strong> nulliparous births, age 35 yrs, multiple gestations, birth weight 4,000 g, gestational age 41 wks)<br />
erature; each provider given -% Medicaid deliveries remained at approximately<br />
own delivery statistics<br />
66%; % <strong>of</strong> Hispanic-surname patients increased<br />
-Staff also agreed on protocols* from 35% in 1989 to 50% in 1998<br />
for active management <strong>of</strong> labor -Caesarean delivery rates: 1989 1998<br />
-VBAC was encouraged Total 16.6% 10.9%<br />
-Nursing staff maintained birth Primary 9.2% 7.1%<br />
logbook (maternal information Repeat deliveries 7.4% 3.8%<br />
and complications, labor infor- Nulliparous 16.4% 11.9%<br />
mation, fetal information); data Multiparous 16.8% 10.5%<br />
Author/Year Design<br />
Type<br />
-In 10-year study period, Caesarean delivery<br />
rates were lowered significantly while not<br />
adversely increasing indicators <strong>of</strong> perinatal<br />
morbidity or death. Most <strong>of</strong> the reduction<br />
was due to increasing the active management<br />
<strong>of</strong> labor and to encouraging VBAC deliveries.<br />
Case<br />
Series<br />
Naiden &<br />
Deshpande<br />
(2001)<br />
Institute for Clinical Systems Improvement<br />
NOTES: *protocol called for oxytocin infusion<br />
only under supervision <strong>of</strong> attending<br />
physician; only allowed nurses with experience<br />
in labor and delivery and assessment <strong>of</strong><br />
fetal heart rate patterns and initial management<br />
<strong>of</strong> abnormal patterns to practice the<br />
protocol<br />
-Significant decrease in rate <strong>of</strong> Caesarean delivery<br />
for cephalopelvic disproportions (p
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