Frigoletto F D, Lieberman E, Lang J M, Cohen A, Barss V, Ringer S, Datta S
Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA.
N Engl J Med. 1995 Sep 21;333(12):745-50. doi: 10.1056/NEJM199509213331201.
Active management of labor is a multifaceted program that, as implemented at the National Maternity Hospital in Dublin, is associated with a lower rate of cesarean delivery than the rate usually found in the United States. We conducted a randomized trial to evaluate the efficacy of this approach in lowering the rate of cesarean section among women delivering their first babies.
We randomly assigned 1934 nulliparous women at low risk of complications of pregnancy, before 30 weeks' gestation, to active management of labor or to a usual-care group. The components of active management were customized childbirth classes; strict criteria for the diagnosis of labor; standardized management of labor, including early amniotomy and treatment with high-dose oxytocin; and one-to-one nursing. A low-risk subgroup was defined as including women with full-term, uncomplicated pregnancies who spontaneously went into labor (the protocol-eligible subgroup). Women meeting these criteria who had been randomly assigned to the active-management group were admitted to a separate unit where their labor was managed by trained, certified nurse-midwives.
There was no difference between groups in the rate of cesarean section either among all women (active management, 19.5 percent; usual care, 19.4 percent) or in the protocol-eligible subgroup (active management, 10.9 percent; usual care, 11.5 percent). In the protocol-eligible subgroup, the median duration of labor was shortened by 2.7 hours by active management (from 8.9 to 6.2 hours), and the rate of maternal fever was lower (7 percent vs. 11 percent, P = 0.007). The percentage of women in whom labor lasted longer than 12 hours was three times higher in the usual-care group than in the active-management group (26 percent vs. 9 percent, P < 0.001).
Active management of labor did not reduce the rate of cesarean section in nulliparous women but was associated with a somewhat shorter duration of labor and less maternal fever.
积极分娩管理是一个多方面的项目，正如在都柏林国家妇产医院实施的那样，与美国通常的剖宫产率相比，其剖宫产率较低。我们进行了一项随机试验，以评估这种方法在降低初产妇剖宫产率方面的疗效。
我们在妊娠30周前，将1934名妊娠并发症低风险的未产妇随机分为积极分娩管理组或常规护理组。积极分娩管理的组成部分包括定制的分娩课程；严格的分娩诊断标准；标准化的分娩管理，包括早期人工破膜和高剂量缩宫素治疗；以及一对一护理。低风险亚组定义为包括足月、无并发症且自然发动分娩的妇女（符合方案亚组）。符合这些标准且被随机分配到积极分娩管理组的妇女被收治到一个单独的单元，由经过培训和认证的护士助产士管理她们的分娩。
在所有妇女中（积极分娩管理组为19.5%，常规护理组为19.4%）以及在符合方案亚组中（积极分娩管理组为10.9%，常规护理组为11.5%），两组之间的剖宫产率没有差异。在符合方案亚组中，积极分娩管理使中位产程缩短了2.7小时（从8.
