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Journal ArticleDOI

Active management of labour and cephalopelvic disproportion

01 May 1970-British Journal of Obstetrics and Gynaecology (John Wiley & Sons, Ltd)-Vol. 77, Iss: 5, pp 385-389
TL;DR: A preoccupation with cephalopelvic disproportion is the main reason for a reluctance to abandon the conservative attitude towards labour which prevails in the United Kingdom and Ireland.
About: This article is published in British Journal of Obstetrics and Gynaecology.The article was published on 1970-05-01. It has received 74 citations till now. The article focuses on the topics: Cephalopelvic disproportion.
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01 Jan 1980
TL;DR: Difficulty in meeting the commitment to early delivery arose almost exclusively in cases in which the diagnosis of labour was in doubt; only seven women were retained in the delivery unit for 12 hours.
Abstract: Active management of labour has been developed to the extent that an assurance is given to every woman who attends this hospital that her first baby will be born within 12 hours. This assurance could lead to a welcome change in present attitudes because the mere prospect of prolonged labour is often a cause of serious concern during a first pregnancy. Labour of strictly limited duration makes it possible to provide every woman with a personal nurse, and it places the problem of pain in a new setting.The results of a prospective study of 1,000 consecutive primigravidae are presented, and the guidelines to a standard policy of management are defined. Difficulty in meeting the commitment to early delivery arose almost exclusively in cases in which the diagnosis of labour was in doubt; only seven women were retained in the delivery unit for 12 hours.

250 citations

Journal ArticleDOI
TL;DR: Each year, approximately 2 million babies die because of complications of childbirth, primarily in settings where effective care at birth, particularly prompt cesarean delivery, is unavailable.

213 citations

Journal ArticleDOI
TL;DR: Early intervention with amniotomy and oxytocin appears to be associated with a modest reduction in the rate of caesarean section over standard care in prevention trials and for the other indicators of maternal or neonatal morbidity.
Abstract: Background Caesarean section rates are over 20% in many developed countries. The main diagnosis contributing to the high rate in nulliparae is dystocia or prolonged labour. The present review assesses the effects of a policy of early amniotomy with early oxytocin administration for the prevention of, or the therapy for, delay in labour progress. Objectives To estimate the effects of early augmentation with amniotomy and oxytocin for prevention of, or therapy for, delay in labour progress on the caesarean birth rate and on indicators of maternal and neonatal morbidity. Search methods We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 May 2013), MEDLINE (1966 to 4 July 2013), Embase (1980 to 4 July 2013), CINAHL (1982 to 4 July 2013), MIDIRS (1985 to 4 July 2013) and contacted authors for data from unpublished trials. Selection criteria Randomized and quasi-randomized controlled trials that compared oxytocin and amniotomy with expectant management. Data collection and analysis Three review authors extracted data independently. We stratified the analyses into 'Prevention Trials' and 'Therapy Trials' according to the status of the woman at the time of randomization. Participants in the 'Prevention Trials' were unselected women, without slow progress in labour, who were randomized to a policy of early augmentation or to routine care. In 'Treatment Trials' women were eligible if they had an established delay in labour progress. Main results For the 2013 update, we identified and excluded one new clinical trial. This updated review includes 14 trials, randomizing a total of 8033 women. The unstratified analysis found early intervention with amniotomy and oxytocin to be associated with a modest reduction in the risk of caesarean section; however, the confidence interval (CI) included the null effect (risk ratio (RR) 0.89; 95% CI 0.79 to 1.01; 14 trials; 8033 women). In prevention trials, early augmentation was associated with a modest reduction in the number of caesarean births (RR 0.87; 95% CI 0.77 to 0.99; 11 trials; 7753). A policy of early amniotomy and early oxytocin was associated with a shortened duration of labour (average mean difference (MD) - 1.28 hours; 95% CI -1.97 to -0.59; eight trials; 4816 women). Sensitivity analyses excluding four trials with a full package of active management did not substantially affect the point estimate for risk of caesarean section (RR 0.87; 95% CI 0.73 to 1.05; 10 trials; 5165 women). We found no other significant effects for the other indicators of maternal or neonatal morbidity. Authors' conclusions In prevention trials, early intervention with amniotomy and oxytocin appears to be associated with a modest reduction in the rate of caesarean section over standard care.

110 citations

Journal ArticleDOI
TL;DR: It is argued that the fall in perinatal mortality which has occurred over the period during which the CS rate has risen is not the main reason for this fall and the training of obstetricians to deal with anxiety, provision of primary maternity care by appropriately trained midwives and general or family practitioners, and changes in management protocols could cut the CSR.

96 citations

Journal ArticleDOI
TL;DR: When used in a double-masked fashion, high-dose oxytocin is associated with significantly shorter labors without any demonstrable adverse fetal or neonatal effects.

85 citations

References
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Journal ArticleDOI
24 May 1969-BMJ
TL;DR: Stimulation, properly supervised, is safe to mother and child, it eliminates the problem of occipitoposterior position, results in a sharp decline in forceps delivery, and obviates the need for massive analgesia.
Abstract: A prospective study of 1,000 consecutive primigravid deliveries has shown that active management in labour can ensure that every woman is delivered within 24 hours. Emphasis is laid on the importance of a correct initial diagnosis of labour based on objective criteria. Amniotomy followed by oxytocin infusion is advocated to simulate the progress of normal labour unless this is evident from an early stage.Oxytocin, the dose of which is limited only by foetal distress, cannot be used effectively unless three popular fallacies are rejected. Firstly, that prolonged labour is often an expression of cephalo-pelvic disproportion; secondly, that oxytocin may rupture the primigravid uterus; and, thirdly, that there is a valid therapeutic distinction between hypotonic and hypertonic uterine action.Stimulation, properly supervised, is safe to mother and child, it eliminates the problem of occipitoposterior position, results in a sharp decline in forceps delivery, and obviates the need for massive analgesia.

187 citations

Journal ArticleDOI
TL;DR: D’Esopo, Moore and Lenzi (1964) have shown that with a favourable cervix, with the vertex dipping into the pelvis and in the absence of cephalo-pelvic disproportion, the risks of elective induction of labour with a dilute oxytocin drip are no greater, and may be even less than, spontaneously occurring labour in a similar group of patients.

76 citations


"Active management of labour and cep..." refers background in this paper

  • ...It has been stated frequently that disproportion is a common cause of protracted labour and that ocytocin should never be given to accelerate progress unless disproportion has been excluded (Hellman, 19 59 ; Friedman and Sachtleben, 1962 ; Turnbull and Anderson, 1968)....

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  • ...Turnbull and Anderson (1968) were especially concerned about the possibility of injury to the fetus resulting in traumatic intracranial haemorrhage, and recommended that only when full clinical and radiological assessment excluded disproportion should oxytocin be used....

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Journal ArticleDOI
TL;DR: A careful perusal of the literature on the pitocin drip finds that the most physiological responses in severe primary uterine inertia have actually been obtained by giving an intravenous infusion of normal saline containing either 10 or 20 units of pitcin to the liter.

46 citations


"Active management of labour and cep..." refers background in this paper

  • ...Theobald et al. (1956) and Hannah (1965) did not consider this a contraindication, and Goodwin and Reid (1963) concluded that oxytocin demonstrated safely and quickly the limits of uterine ability in trial of labour....

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Journal Article
TL;DR: This analysis of 1000 such labor graphs, including 500 primigravidas and 500 multigravida, supports the viewpoint that they are precise guides for the management of abnormal labors.

16 citations


Additional excerpts

  • ...Ledger (1969) advocated an aggressive policy towards labour in patients with abnormal patterns of cervical dilatation, provided there was no cephalopelvic disproportion, and Hellman (1 959) warned that pelvic contraction even of a minor degree was the principal contraindication to stimulation....

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