Labour assessment programs to delay admission to labour wards

Abstract

Background: The aim of labour assessment programs is to delay hospital admission until labour is in the active phase, and thereby to prevent unnecessary interventions in women who are not in established labour.

Objectives: The objective of this review was to assess the effects of labour assessment programs that aim to delay hospital admission until labour is in the active phase.

Search strategy: We searched the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register. Date of last search: January 2001.

Selection criteria: Randomised trials which compare labour assessment programs with direct admission to labour wards.

Data collection and analysis: Trial quality was assessed.

Main results: One study of 209 women was included. The trial was of excellent quality. Women who were randomised to the labour assessment unit spent less time in the labour ward (weighted mean difference -5.20 hours, 95% confidence interval -7.06, -3.34), were less likely to receive intrapartum oxytocics (odds ratio 0.45, 95% confidence interval 0.25 to 0.80) and analgesia (odds ratio 0.36, 95% confidence interval 0.16 to 0.78), than women who were admitted directly to the labour ward. Women in the labour assessment group reported higher levels of control during labour (weighted mean difference 16.00, 95% confidence interval 7.52 to 24.48). There is insufficient evidence to assess effects on rate of caesarean section and other important measures of maternal and neonatal outcome.

Reviewer's conclusions: Labour assessment programs, which aim to delay hospital admission until active labour, may benefit women with term pregnancies.