Active management in labour might possibly be effective for slightly reducing the caesarean section rates in low-risk pregnancies compared to routine care, but at the cost of increasing interventions.
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).
1. Brown HC, Paranjothy S, Dowswell T, Thomas J. Package of care for active management in labour for reducing caesarean section rates in low-risk women. Cochrane Database Syst Rev. 2008;(4):CD004907 [Review content assessed as up-to-date: 27 June 2013].
Copyright © 2020 Duodecim Medical Publications Limited.
Active management in labour for reducing caesarean section rates in low-risk women
is a sample topic from the Evidence-Based Medicine Guidelines
To view other topics, please sign in or purchase a subscription.
Evidence Central is an integrated web and mobile solution that helps clinicians quickly answer etiology, diagnosis, treatment, and prognosis questions using the latest evidence-based research. Complete Product Information.
"Active Management in Labour for Reducing Caesarean Section Rates in Low-risk Women." Evidence-Based Medicine Guidelines, Duodecim Medical Publications Limited, 2019. Evidence Central, evidence.unboundmedicine.com/evidence/view/EBMG/456888/all/Active_management_in_labour_for_reducing_caesarean_section_rates_in_low_risk_women.
Active management in labour for reducing caesarean section rates in low-risk women. Evidence-Based Medicine Guidelines. Duodecim Medical Publications Limited; 2019. https://evidence.unboundmedicine.com/evidence/view/EBMG/456888/all/Active_management_in_labour_for_reducing_caesarean_section_rates_in_low_risk_women. Accessed October 31, 2020.
Active management in labour for reducing caesarean section rates in low-risk women. (2019). In Evidence-Based Medicine Guidelines. Duodecim Medical Publications Limited. Retrieved October 31, 2020, from https://evidence.unboundmedicine.com/evidence/view/EBMG/456888/all/Active_management_in_labour_for_reducing_caesarean_section_rates_in_low_risk_women
Active Management in Labour for Reducing Caesarean Section Rates in Low-risk Women [Internet]. In: Evidence-Based Medicine Guidelines. Duodecim Medical Publications Limited; 2019. [cited 2020 October 31]. Available from: https://evidence.unboundmedicine.com/evidence/view/EBMG/456888/all/Active_management_in_labour_for_reducing_caesarean_section_rates_in_low_risk_women.
TY - ELEC
T1 - Active management in labour for reducing caesarean section rates in low-risk women
ID - 456888
BT - Evidence-Based Medicine Guidelines
UR - https://evidence.unboundmedicine.com/evidence/view/EBMG/456888/all/Active_management_in_labour_for_reducing_caesarean_section_rates_in_low_risk_women
PB - Duodecim Medical Publications Limited
DB - Evidence Central
DP - Unbound Medicine