Management of Labor
Management of Labor
Management of Labor
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Conclusion Grading Worksheet B – Annotation #66 <strong>Management</strong> <strong>of</strong> <strong>Labor</strong><br />
(<strong>Management</strong> <strong>of</strong> Protracted <strong>Labor</strong>) Third Edition/May 2009<br />
Authors' Conclusions/<br />
Work Group's Comments (italicized)<br />
Population Studied/Sample Size Primary Outcome Measure(s)/Results (e.g., p-value,<br />
confidence interval, relative risk, odds ratio, likelihood<br />
ratio, number needed to treat)<br />
-Intention-to-treat (ITT) analysis: all randomized<br />
ble; 1934 (64%) agreed to par- -Protocol-eligible subgroup analysis: those medicalticipate<br />
and were randomized to ly eligible to receive treatment according to protocol<br />
Class Quality<br />
+,–,ø<br />
Author/Year Design<br />
Type<br />
-The safety <strong>of</strong> an active management protocol<br />
was confirmed. No substantial decrease<br />
in the rate <strong>of</strong> Caesarean delivery was observed.<br />
RCT A ø -3,028 nulliparous women eligi-<br />
Frigoletto, Lieberman,<br />
Lang,<br />
et al. (1995)<br />
at time <strong>of</strong> onset <strong>of</strong> labor<br />
-ITT analysis: data from 1915 patients; Caesarean<br />
rate was 19.5% in active mgmt group and 19.4% in<br />
usual care group; results unchanged when adjusted<br />
for baseline characteristics or epidural anesthesia<br />
use; Caesarean rates due to failure to progress were<br />
7% in active mgmt and 8% in usual care groups<br />
-Subgroup analysis:<br />
a. 33% <strong>of</strong> the active mgmt group and 35% <strong>of</strong> the<br />
usual care group developed medical complications<br />
or had labor induced and were ineligible; the protocol-eligible<br />
subgroup included 678 in active mgmt<br />
and 585 in usual care; 633 in active mgmt group<br />
were treated according to protocol<br />
b. Groups did not differ at baseline<br />
c. Active mgmt group had more frequent vaginal exams,<br />
had membranes ruptured artificially more <strong>of</strong>ten<br />
(and earlier), were more likely to receive oxytocin,<br />
had higher maximal dose <strong>of</strong> oxytocin, requested<br />
epidural anesthesia less <strong>of</strong>ten (p2 hrs (>3 hrs if<br />
epidural catheter)<br />
-Usual Care Group: no constraints<br />
on physicians<br />
Institute for Clinical Systems Improvement<br />
shorter labor in active mgmt group (6.2 hrs vs. 8.9<br />
hrs)<br />
e. Lower incidence <strong>of</strong> maternal fever in active mgmt<br />
group (RR=0.6); other complications were same for<br />
both groups; no differences in infants' outcomes<br />
www.icsi.org<br />
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