UK STUDY OF INTRAPARTUM CARE FOR LOW-RISK PRIMIGRAVIDAS - A SURVEY OFINTERVENTIONS

Study objective-To determine the extent of intrapartum intervention re ceived by primigravidas. Design-Cross sectional survey of NHS hospital s in the UK. Setting-One hundred and one randomly selected hospital ma ternity units. Participants-Forty consecutive primigravid women, judge d to be at low risk at the start of labour, in each hospital. Main out come measures-Seven groups of interventions or monitoring procedures w ere identified from the first, second, and third stages of labour: fet al monitoring, vaginal examinations, artificial rupture of membranes, augmentation of labour, pain relief, type of delivery, and episiotomy. Data were collected during 1993. Main results-Ninety eight hospitals took part in the study and data were collected on 3160 low risk primig ravidas. Seventy four per cent of these women had continuous cardiotoc ography. The proportion of women having restrictive or invasive fetal monitoring showed appreciable geographical variation for both the firs t and second stages of labour. Using the criterion of a vaginal examin ation every four hours and allowing for the length of each woman's lab our, 72% had more vaginal examinations than expected; there was a sign ificant geographical variation in the number of women receiving more t han five examinations. Fifty three per cent had artificial rupture of membranes; the procedure was performed over a wide range of cervical d ilatations (0 cm-10 cm). Thirty eight per cent of labours were augment ed, most commonly by intravenous syntocinon; the procedure showed sign ificant geographical variation. Twenty eight per cent had a spinal blo ck or epidural analgesia for the relief of pain; this intervention var ied by geographical region only for the second stage of labour. Over o ne quarter of the women required instrumental delivery. Forty six per cent had an episiotomy; the frequency of this intervention varied subs tantially by region. There were no infant deaths. Twelve babies were r ecorded at birth as having a congenital anomaly. Conclusions-The rates of several interventions seem high for this low risk group and there was substantial geographical variation in the use of six interventions . Clinical trials are needed to evaluate the optimum criteria for usin g these interventions from which guidelines should be drawn up by loca l groups and the Royal College.