The continuing effectiveness of active management of first labor, despite a doubling in overall nulliparous cesarean delivery.

Abstract:

OBJECTIVE:The purpose of this study was to determine the continuing effectiveness of active management of labor, a protocol that involves early detection and correction of dystocia with oxytocin in spontaneous cephalic nulliparous labor, by analysis of the contribution of this cohort to a doubled overall nulliparous cesarean delivery rate. STUDY DESIGN:This was a retrospective analysis of annually collated institutional data on cesarean delivery and perinatal outcome. RESULTS:From 1989 to 2000, 81,855 women were delivered at the National Maternity Hospital, of whom 34,201 women (42%) were nulliparous; the annual proportion of nulliparous women in spontaneous labor decreased progressively from 83% to 60%; the overall nulliparous cesarean rate increased from 8.1% to 16.6%. Cesarean birth rate among nulliparous women in spontaneous labor, although showing a significant upward trend between 1989 and 2000 (2.4%-4.8%; P = .001), was stable, averaging 5% for the last 8 years (P = .705); the peripartum death rate in this group fell significantly (P = .024). Comparing results for 1989 with results for 2000, nulliparous women in spontaneous labor accounted for 14% of the overall increase in cesarean deliveries (dystocia, 5%), compared with 51% for nulliparous women with induced labor. The perinatal mortality rate in term infants was unchanged. CONCLUSION:Active management of spontaneous first labors remains an effective protocol for the promotion of vaginal delivery with low peripartum mortality rates; factors other than dystocia in spontaneous labor account for the progressive increase in the nulliparous cesarean delivery rate.

journal_name

Am J Obstet Gynecol

authors

Foley ME,Alarab M,Daly L,Keane D,Rath A,O'herlihy C

doi

10.1016/j.ajog.2004.05.072

subject

Has Abstract

pub_date

2004-09-01 00:00:00

pages

891-5

issue

3

eissn

0002-9378

issn

1097-6868

pii

S0002937804005575

journal_volume

191

pub_type

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