A Cochrane review 1 included 7 studies with a total of 5390 nulliparous women. Active management includes routine amniotomy, strict rules for diagnosing slow progress, use of oxytocin and one-to-one care. The caesarean section (CS) rate was slightly lower in the active management group compared to routine care group (RR 0.88, 95% CI 0.77 to 1.01; 7 trials, n=5390). On excluding a study with a large number of post-randomisation exclusions, CS rates in the active management group were significantly lower than in the routine care group (RR 0.77 95% CI 0.63 to 0.94; 6 trials n=3475). 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. The majority of women (over 75%) in both groups were very satisfied with care in one trial.
Comment: The quality of evidence is downgraded by study quality (e.g. inadequate blinding), by inconsistency and indirectness (differences in studied interventions both in the intervention and the comparison groups).
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