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

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 < 001) 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.