Active management of labour versus expectant management of primiparous women with a prolonged latent phase: a randomized trial

ABSTRACT

Objective. Our study aimed to compare the outcomes of expectant management to those of active management strategy in the case of a prolonged latent phase.

Patients and Methods. We included 340 primiparous women with spontaneous labour beginning and with prolonged latent phase. Only single evolutive pregnancies with cephalic presentation were included. For Active Management Group (AMG), the intervention was an amniotomy followed by an oxytocin infusion. For the expectant management group (EMG), amniotomy and oxytocin infusion were not performed unless indicated.

Results. The caesarean section rate was 27.6% for the EMG versus 43.5% for the AMG (p < 0.001). Immediate complications were found in 18.2% of patients for the AMG versus 2.9% for the EMG (p < 0.001). 93.5% of newborns for the EMG had an APGAR score between 8 and 10 versus 84.7% for the AMG (p = 0.01). Medical reanimation was required for 25 newborns after AMG and for 10 cases with EMG (p = 0.01). Five newborns for EMG (2.9%) and 15 newborns for GPA (8.8%) were admitted to the neonatal intensive care unit (p = 0.03). The mean duration of the latent phase was 20 hours and 38 minutes for the EMG versus 13 hours and 19 minutes for the AMG (p < 0.001). The average duration of the active phase, for patients who had vaginal birth, was 5 hours and 14 minutes for the EMG versus 3 hours and 58 minutes for the AMG (p < 0.001).

Conclusions. The active attitude has shown several disadvantages: it gives a higher caesarean section rate, more maternal complications, less safety for the newborn, and a longer hospital stay with less satisfied parturient. Expectant management to manage the prolonged latent phase seems to be an effective alternative.