Low-risk labor - outcomes after introduction of special guidelines combined with increased awareness of risk category

Abstract

Objective: To study whether special guidelines for low-risk parturients combined with increased awareness of risk category affect the management of labor.

Design: Hospital-based registry study.

Setting: Two identical birth units in one university hospital in Oslo, Norway.

Population: All low-risk parturient women in the years 2001-2009; a total of 28 533 deliveries.

Methods: From September 2005, a special protocol for management of low-risk labors was introduced in one of the units. Data were obtained from standardized patient records, routinely recorded electronically. Outcomes were extracted for each year, and for the years 2006-2009 the outcomes for the two units were compared. Logistic regression was used to study factors associated with spontaneous vaginal delivery.

Main outcome measures: Delivery method, use of electronic fetal monitoring, use of oxytocin, duration of labor and Apgar score at five minutes.

Results: For nulliparas, the unit with special guidelines had a slightly higher rate of spontaneous vaginal deliveries (76 vs. 72.5%, p=0.006), lower use of oxytocin (48.8 vs. 56.1%, p<0.001) and electronic fetal monitoring (63.8 vs. 69.4%, p<0.001) and longer duration of labor. In multiparas, there was a small difference (15.5 vs. 18.4%, p=0.003) in the use of oxytocin. In a logistic regression, spontaneous vaginal delivery in nulliparas was negatively associated with use of oxytocin and electronic fetal monitoring, but not with the birth unit.

Conclusions: A special protocol to increase awareness of risk category led to a small, although statistically significant, increase in the rate of spontaneous vaginal delivery in nulliparous, but not in parous low-risk parturients.