A randomised controlled trial of early versus delayed use of amniotomy and oxytocin infusion in nulliparous labour

Abstract

Objective: To compare routine amniotomy and early intravenous oxytocin (active management of labour) with a more selective use of amniotomy and oxytocin in women in true labour who received comparable continuous supportive midwifery care.

Design: Randomised controlled trial of nulliparous clinic patients in spontaneous labour at term.

Setting: Labour and delivery ward of a university teaching hospital.

Participants: Three hundred and six parturients: 152 received active management of labour; 154 were more selectively managed.

Interventions: 1. Active management: early amniotomy, early use of oxytocin. 2. Selective intervention management: no routine amniotomy and more selective use of oxytocin.

Outcome measures: Use of oxytocin and amniotomy. Labour duration, mode of delivery.

Results: Maternal characteristics were comparable in both groups. Amniotomy was more often performed (91% versus 57%, P <0.01) and oxytocin more often used (53% versus 27%, P < 0.01) in the active management group. The first stage of labour, however, was only shortened by half an hour in the active management group (254 min versus 283 min, P = 0.087). Caesarean section rate (3.9% versus 2.6%), spontaneous vaginal delivery rate (78% versus 79%) and neonatal outcome were not significantly different between groups.

Conclusion: Within a set-up of strict labour diagnosis and supportive midwifery care, routine amniotomy and early use of oxytocin offered no advantage over a more selective use of amniotomy and oxytocin in terms of mode of delivery and labour duration.