ACTIVE-PHASE LABOR ARREST - A RANDOMIZED TRIAL OF CHORIOAMNION MANAGEMENT

Objective: To determine whether leaving the membranes intact in active -phase arrest would affect the cesarean delivery rate or the incidence of maternal morbidity secondary to infection. Methods: We conducted a randomized trial of healthy, spontaneously laboring women at term wit h an intact chorioamnion and active-phase arrest (defined as 1 cm or l ess of cervical change over 2 hours in the active phase of labor). Pat ients were assigned to either oxytocin augmentation with intact chorio amnion or oxytocin augmentation with amniotomy and internal monitoring of the fetal heart rate and; uterine contractions. Results: The intac t group (n = 58) and the amniotomy group (n = 60) were similar with re spect to maternal age, race, parity, labor epidural usage, gestational age, cervical dilatation at randomization, number of vaginal examinat ions, and infant birth weight. Four patients in the intact group and f ive in the amniotomy group underwent cesarean delivery (P = 1.0). No p atients in the intact group and three in the amniotomy group were diag nosed with chorioamnionitis (P = .24). Endometritis did not occur in t he intact group, whereas four cases occurred in the amniotomy group (P = .12). There were no cases of maternal infection in the intact group , versus seven in the amniotomy group (P = .01). The interval between randomization and vaginal delivery was 44 minutes longer in the intact group than in the amniotomy group (P = .11). Conclusion: In women wit h active-phase arrest of labor and intact membranes, oxytocin augmenta tion with elective amniotomy and internal monitoring increases materna l infectious morbidity.