Effects of algorithm for diagnosis of active labour

Helen Cheyne, Vanora Hundley, Dawn Dowding, J Martin Bland, Paul McNamee, Ian Greer, Maggie Styles, Carol A Barnett, Graham Scotland, Catherine Niven

Research output: Contribution to journalArticle

36 Citations (Scopus)

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.
Original languageEnglish
Pages (from-to)1-12
JournalBMJ
Volume337
DOIs
Publication statusPublished - 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

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    Cheyne, H., Hundley, V., Dowding, D., Bland, J. M., McNamee, P., Greer, I., Styles, M., Barnett, C. A., Scotland, G., & Niven, C. (2008). Effects of algorithm for diagnosis of active labour. BMJ, 337, 1-12. https://doi.org/10.1136/bmj.a2396