Active management of labor: Does it make a difference?

Rogers, Rebecca G.; Gilson, George J.; Miller, Anthony C.; Izquierdo, Luis A.; Curet, Luis B.; Qualls, Clifford

doi:10.1016/s0002-9378(97)70152-2

Cited by 94 publications

(52 citation statements)

References 17 publications

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“…Using our common SD of $529.00 for the costs, our sample sizes are able to detect $148.00 differences in average costs between the two protocols, with 80% power analysis and an ␣ of 0.05. 10 reported that the duration of labor in the group whose labor was actively managed was significantly shortened by 1.7 hours compared with that in a control group (active management, 9.7 hours, vs control group, 11.4 hours; P= 0.001). In addition, a trend toward a decreased cesarean section rate was observed in the actively managed group that was not statistically significant (active management, 7.5%, vs control group, 11.7%; P= 0.36).…”

Section: Participants and Methodsmentioning

confidence: 97%

“…10 Briefly, nulliparous women (N=405) were randomly assigned to an active management of labor (n=200) or a control protocol. The active management protocol consisted of a strict diagnosis of labor based on regular palpable uterine contractions and a cervical effacement of at least 80%.…”

Section: Participants and Methodsmentioning

confidence: 99%

“…Three randomized studies have been done to evaluate the efficacy of active management of labor. [8][9][10] These studies have demonstrated significant decreases in the duration of labor and the incidence of infectious morbidity, as well as a trend toward lower cesarean section rates.Rogers et al 10 reported their experience with a protocol of active management of labor at the University of New Mexico Health Sciences Center, Albuquerque. A randomized trial, carried out between August 1992 and April 1996, compared two protocols, one using an active management of labor and the other a standard management of labor.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

“…Rogers et al 10 reported their experience with a protocol of active management of labor at the University of New Mexico Health Sciences Center, Albuquerque. A randomized trial, carried out between August 1992 and April 1996, compared two protocols, one using an active management of labor and the other a standard management of labor.…”

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confidence: 99%

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Active management of labor: a cost analysis of a randomized controlled trial

Rogers¹

2000

Western Journal of Medicine

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ⅷ Objective To compare the costs of a protocol of active management of labor with those of traditional labor management. ⅷ Design Cost analysis of a randomized controlled trial. ⅷ Methods From August 1992 to April 1996, we randomly allocated 405 women whose infants were delivered at the University of New Mexico Health Sciences Center, Albuquerque, to an active management of labor protocol that had substantially reduced the duration of labor or a control protocol. We calculated the average cost for each delivery, using both actual costs and charges. ⅷ Results The average cost for women assigned to the active management protocol was $2,480.79 compared with an average cost of $2,528.61 for women in the control group (P = 0.55). For women whose infant was delivered by cesarean section, the average cost was $4,771.54 for active management of labor and $4,468.89 for the control protocol (P = 0.16). Spontaneous vaginal deliveries cost an average of $27.00 more for actively managed patients compared with the cost for the control protocol. ⅷ Conclusions The reduced duration of labor by active management did not translate into significant cost savings. Overall, an average cost saving of only $47.91, or 2%, was achieved for labors that were actively managed. This reduction in cost was due to a decrease in the rate of cesarean sections in women whose labor was actively managed and not to a decreased duration of labor.Many obstetricians are concerned about the increase in the rate of cesarean sections in the United States. In 1970, the overall incidence of cesarean section was 5%. 1 By 1983, the rate had increased to 21%; it peaked at 24.7% in 1988 2,3 and remains greater than 20% of all deliveries. 4 Lowering the rate of cesarean delivery decreases maternal risk for associated morbidity and should, therefore, significantly decrease the costs of delivery.The active management of labor, first introduced by O'Driscoll et al in the 1960s at the National Maternity Hospital in Dublin, Ireland, 5 is a group of interventions initially devised to ensure short labors in nulliparous women. In addition, active management of labor was noted to be associated with a lower cesarean section rate, 6,7 which was thought to be due to a decrease in the number of cesarean deliveries performed for dystocia. Three randomized studies have been done to evaluate the efficacy of active management of labor. [8][9][10] These studies have demonstrated significant decreases in the duration of labor and the incidence of infectious morbidity, as well as a trend toward lower cesarean section rates.Rogers et al 10 reported their experience with a protocol of active management of labor at the University of New Mexico Health Sciences Center, Albuquerque. A randomized trial, carried out between August 1992 and April 1996, compared two protocols, one using an active management of labor and the other a standard management of labor. No significant differences between the patient populations, neonatal outcomes, the incidence of uterine hyperstimulation, the...

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Section: Participants and Methodsmentioning

confidence: 97%

Section: Participants and Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Active management of labor: a cost analysis of a randomized controlled trial

Rogers¹

2000

Western Journal of Medicine

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Package of care for active management in labour for reducing caesarean section rates in low-risk women

Brown

Paranjothy

Dowswell

et al. 2008

Cochrane Database of Systematic Reviews

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Background Approximately 15% of women have caesarean sections (CS) and while the rate varies, the number is increasing in many countries. This is of concern because higher CS rates do not confer additional health gain but may adversely affect maternal health and have implications for future pregnancies. Active management of labour has been proposed as a means of reducing CS rates. This refers to a package of care including strict diagnosis of labour, routine amniotomy, oxytocin for slow progress and one to one support in labour. Objectives To determine whether active management of labour reduces CS rates in low-risk women and improves satisfaction. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (February 2008), MEDLINE (1966 to December 2007), EMBASE (1980 to 2007), MIDIRS (1985 to 2007) and CINAHL (1982 to 2007). Selection criteria Randomised controlled trials comparing low-risk women receiving a predefined package of care (active management) with women receiving routine (variable) care. Trials where slow progress had been diagnosed before entry into the trial were excluded. Data collection and analysis At least two review authors extracted data. We assessed included studies for risk of bias. Main results We included seven trials, with a total of 5390 women. The quality of studies was mixed. The CS rate was slightly lower in the active management group compared to the group that received routine care, but this difference did not reach statistical significance (RR 0.88, 95% CI 0.77 to 1.01). However, in one study there was a large number of post-randomisation exclusions. On excluding this study, CS rates in the active management group were statistically significantly lower than in the routine care group (RR 0.77 95% CI 0.63 to 0.94). More women in the active management group had labours lasting less than twelve hours, but there was wide variation in length of labour within and between trials. There were no differences between groups in use of analgesia, rates of assisted vaginal deliveries or maternal or neonatal complications. Only one trial examined maternal satisfaction; the majority of women (over 75%) in both groups were very satisfied with care. Authors’ conclusions Active management is associated with small reductions in the CS rate, but it is highly prescriptive and interventional. It is possible that some components of the active management package are more effective than others. Further work is required to determine the acceptability of active management to women in labour.

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Package of care for active management in labour for reducing caesarean section rates in low-risk women

Brown

Paranjothy

Dowswell

et al. 2013

Cochrane Database of Systematic Reviews

View full text Add to dashboard Cite

Background-Approximately 15% of women have caesarean sections (CS) and while the rate varies, the number is increasing in many countries. This is of concern because higher CS rates do not confer additional health gain but may adversely affect maternal health and have implications for future pregnancies. Active management of labour has been proposed as a means of reducing CS rates. This refers to a package of care including strict diagnosis of labour, routine amniotomy, oxytocin for slow progress and one to one support in labour. Objectives-To determine whether active management of labour reduces CS rates in low-risk women and improves satisfaction. Search methods-We searched the Cochrane Pregnancy and Childbirth Group's Trials

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Active management of labor: Does it make a difference?

Cited by 94 publications

References 17 publications

Active management of labor: a cost analysis of a randomized controlled trial

Active management of labor: a cost analysis of a randomized controlled trial

Package of care for active management in labour for reducing caesarean section rates in low-risk women

Package of care for active management in labour for reducing caesarean section rates in low-risk women

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