Management of Labor

Conclusion Grading Worksheet B – Annotation #66 Management of Labor
(Management of Protracted Labor) Third Edition/May 2009
Authors' Conclusions/
Work Group's Comments (italicized)
Class Qual- Population Studied/Sample Size Primary Outcome Measure(s)/Results (e.g., p-value,
ity
confidence interval, relative risk, odds ratio, likeli-
+,–,ø
hood ratio, number needed to treat)
C – -1000 consecutive nulliparous -Mode of Delivery:
women in labor after 32 wks
Spontaneous Labor Induced Labor Total
gestation with a cephalic pres-
(n=614) (n=386) (n=1000)
entation and a single, live fetus; Normal 81% 71% 77%
labor confirmed
Low Cavity Forc. 13% 18% 15%
-Progress of labor monitored by Rotational Forc. 3% 3% 3%
vaginal assessment every 2 hrs; Caesarean 3% 9% 6%
progress in 1st stage measured -2.5% had CS for dystocia; 3% for fetal distress;
by cervical dilatation; progress 0.3% for cephalopelvic disproportion; 0.2% for cord
in 2nd stage measured by de- prolapse
scent of head; failure to progress -There were no CS for dystocia after spontaneous
treated with oxytocin
onset of labor; 13 after induced labor
-Labor induced if necessary -Oxytocin used during 1st stage for 31% and during
-Electronic fetal heart rate 2nd stage for 13%
monitoring used routinely -4% were in labor for >12 hrs
-Duration of labor was from -No intrapartum fetal deaths; 1 neonatal death due to
time of admission to delivery congenital heart lesion; 1 death 11 days postpartum
suite in labor
due to perinatal asphyxia (related to use of oxytocin
despite fetal distress); no neonatal seizures
-Compared to data from previous 4 years: fewer CS
(p