Thornton J G, Lilford R J
Institute of Epidemiology, University of Leeds.
BMJ. 1994 Aug 6;309(6951):366-9. doi: 10.1136/bmj.309.6951.366.
To review the evidence that the package of labour interventions collectively called "active management"--namely, strict diagnostic criteria for labour, early amniotomy, early use of oxytocin, and continuous professional support--reduce rates of caesarean sections and operative vaginal delivery in first labours.
Review of observational data, supplemented by evidence from four separate overviews of relevant randomised trials previously published as part of the Cochrane Collaboration pregnancy and childbirth database.
Observational data do not permit a clear conclusion. There have been no randomised trials of the total package of active management or of the use of strict diagnostic criteria alone, but trials of early amniotomy, early oxytocin, and these interventions combined do not suggest that these interventions are effective in reducing rates of caesarean sections or operative vaginal deliveries. In contrast, the provision of continuous professional support in labour seems to reduce both types of operative delivery, although the effect on caesarean sections is confined to those settings where non-professional companions are not normally present in labour.
Delivery units should endeavour to provide continuous professional support in labour, but routine use of amniotomy and early oxytocin is not recommended.
回顾一系列统称为“积极管理”的产时干预措施的证据，即严格的产程诊断标准、早期人工破膜、早期使用缩宫素以及持续的专业支持，是否能降低初产妇剖宫产和阴道助产的发生率。
对观察性数据进行回顾，并辅以先前作为Cochrane协作网妊娠与分娩数据库一部分发表的四项相关随机试验独立综述的证据。
观察性数据无法得出明确结论。目前尚无关于积极管理整套措施或仅使用严格诊断标准的随机试验，但早期人工破膜、早期使用缩宫素以及这些干预措施联合应用的试验表明，这些干预措施在降低剖宫产率或阴道助产率方面并无效果。相比之下，产时提供持续的专业支持似乎能降低这两种助产方式的发生率，不过对剖宫产率的影响仅限于那些产时通常没有非专业陪伴人员的情况。
分娩单位应努力在产时提供持续的专业支持，但不建议常规使用人工破膜和早期缩宫素。
