Objective To compare the effectiveness of an algorithm for diagnosis
of active labour in primiparous women with standard care in terms of maternal
and neonatal outcomes.
Design Cluster randomised trial.
Setting Maternity units in Scotland with at least 800 annual births.
Participants 4503 women giving birth for the first time, in 14
maternity units. Seven experimental clusters collected data from a baseline
sample of 1029 women and a post-implementation sample of 896 women. The seven
control clusters had a baseline sample of 1291 women and a post-implementation
sample of 1287 women.
Intervention Use of an algorithm by midwives to assist their
diagnosis of active labour, compared with standard care.
Main outcomes Primary outcome: use of oxytocin for augmentation of
labour. Secondary outcomes: medical interventions in labour, admission
management, and birth outcome.
Results No significant difference was found between groups in
percentage use of oxytocin for augmentation of labour (experimental minus
control, difference=0.3, 95% confidence interval −9.2 to 9.8; P=0.9) or in the
use of medical interventions in labour. Women in the algorithm group were more
likely to be discharged from the labour suite after their first labour
assessment (difference=−19.2, −29.9 to −8.6; P=0.002) and to have more
pre-labour admissions (0.29, 0.04 to 0.55; P=0.03).
Conclusions Use of an algorithm to assist midwives with the
diagnosis of active labour in primiparous women did not result in a reduction in
oxytocin use or in medical intervention in spontaneous labour. Significantly
more women in the experimental group were discharged home after their first
labour ward assessment.
Trial registration Current Controlled Trials ISRCTN00522952.