Abstract
OBJECTIVE: To compare the effectiveness of an algorithm for diagnosis of active labour in primiparous women with standard care in terms of maternal and neonatal outcomes.
DESIGN: Cluster randomised trial.SETTING: Maternity units in Scotland with at least 800 annual births.
PARTICIPANTS: 4503 women giving birth for the first time, in 14 maternity units. Seven experimental clusters collected data from a baseline sample of 1029 women and a post-implementation sample of 896 women. The seven control clusters had a baseline sample of 1291 women and a post-implementation sample of 1287 women.
INTERVENTION: Use of an algorithm by midwives to assist their diagnosis of active labour, compared with standard care. Main outcomes Primary outcome: use of oxytocin for augmentation of labour.SECONDARY OUTCOMES: medical interventions in labour, admission management, and birth outcome.
RESULTS: No significant difference was found between groups in percentage use of oxytocin for augmentation of labour (experimental minus control, difference=0.3, 95% confidence interval -9.2 to 9.8; P=0.9) or in the use of medical interventions in labour. Women in the algorithm group were more likely to be discharged from the labour suite after their first labour assessment (difference=-19.2, -29.9 to -8.6; P=0.002) and to have more pre-labour admissions (0.29, 0.04 to 0.55; P=0.03).
CONCLUSIONS: Use of an algorithm to assist midwives with the diagnosis of active labour in primiparous women did not result in a reduction in oxytocin use or in medical intervention in spontaneous labour. Significantly more women in the experimental group were discharged home after their first labour ward assessment.
TRIAL REGISTRATION: Current Controlled Trials ISRCTN00522952.
DESIGN: Cluster randomised trial.SETTING: Maternity units in Scotland with at least 800 annual births.
PARTICIPANTS: 4503 women giving birth for the first time, in 14 maternity units. Seven experimental clusters collected data from a baseline sample of 1029 women and a post-implementation sample of 896 women. The seven control clusters had a baseline sample of 1291 women and a post-implementation sample of 1287 women.
INTERVENTION: Use of an algorithm by midwives to assist their diagnosis of active labour, compared with standard care. Main outcomes Primary outcome: use of oxytocin for augmentation of labour.SECONDARY OUTCOMES: medical interventions in labour, admission management, and birth outcome.
RESULTS: No significant difference was found between groups in percentage use of oxytocin for augmentation of labour (experimental minus control, difference=0.3, 95% confidence interval -9.2 to 9.8; P=0.9) or in the use of medical interventions in labour. Women in the algorithm group were more likely to be discharged from the labour suite after their first labour assessment (difference=-19.2, -29.9 to -8.6; P=0.002) and to have more pre-labour admissions (0.29, 0.04 to 0.55; P=0.03).
CONCLUSIONS: Use of an algorithm to assist midwives with the diagnosis of active labour in primiparous women did not result in a reduction in oxytocin use or in medical intervention in spontaneous labour. Significantly more women in the experimental group were discharged home after their first labour ward assessment.
TRIAL REGISTRATION: Current Controlled Trials ISRCTN00522952.
| Original language | English |
|---|---|
| Pages (from-to) | 1-12 |
| Journal | BMJ |
| Volume | 337 |
| DOIs | |
| Publication status | Published - 08 Dec 2008 |
Keywords
- Adolescent
- Adult
- Algorithms
- Cluster Analysis
- Female
- Humans
- Labor, Obstetric
- Nurse Midwives
- Oxytocics
- Oxytocin
- Pregnancy
- Pregnancy Outcome
- Prenatal Care
- Professional Practice
- Scotland
- Young Adult
- Journal Article
- Multicenter Study
- Randomized Controlled Trial
- Research Support, Non-U.S. Gov't