Comparison of active management of labour versus “traditional” approach

Background: Management of spontaneous labour is an important issue. Dystocia accounts for increased rate of LSCS. Prolonged labours are associated with higher maternal and neonatal morbidity. With active management, these complications could be reduced. Aims: To study outcome of labour, maternal & perinatal morbidity and mortality with active management of labour. Methods:100 primigravidas, at term were randomly assigned to 2 groups-study group-active management (N = 50) and control group (n=50). Women in active group were managed by early amniotomy and augmentation with Oxytocin at 6mIU/ml. In the control group, women received conservative care, amniotomy after 6cm dilatation and oxytocin at 1mIU/ml. In both groups labour was monitored using modified WHO partogram. Caesarean was done for standard obstetric indications. Results-In active management caesarean rate was 12 percent, as compared with 18 percent in control. Mean length of labour in study group was 5.6 hrs as compared to 7.1 in control group. The 6 percent reduction in the caesarean section rate was primarily due to a decrease in incidence of dystocia. With active management, the average length of labour was shortened by 1.5 hours, because of early amniotomy and oxytocin. No statistical difference was seen in both groups as regards to mortality and morbidity. Conclusions: Active management of labour reduces the incidence of dystocia, decreases duration of labour and increases the rate of vaginal delivery without increasing maternal or neonatal morbidity.