Active management of labor: is it suitable for a developing country?

Objective: To evaluate the effectiveness of active management of labor in t he setting of a developing country. Methods: This historical cohort study c ompared the labor characteristics and outcome of all anti-HIV positive null iparous pregnant women (n = 96), who delivered between January 1991 and Mar ch 1999, treated with traditional labor management to all anti-HIV negative nulliparous pregnant women (n = 1856), who delivered in 1998, treated with active management of labor in the tertiary center of a developing country. The year 1998 was chosen by using the total cesarean section rate of nulli parous patients from 1991 to 1998 to find the mean, then selected the year with cesarean section rate nearest to the mean as a control. Data were anal yzed by the chi-square and t-tests. Results: The length of labor was signif icantly shortened in the active management group (6.3 +/- 3.3 h vs. 8.9 +/- 6 h, P < 0.001). A significantly greater proportion of the traditional man agement group had prolonged labor (29.3% vs. 4.9%, P < 0.001). However, the cesarean section rate was not different between the two groups (active vs. traditional = 17% vs. 14.6%, P = 0.7) with dystocia as a major indication in both groups. Maternal acid fetal complications were not different. Concl usion: The active management of labor shortened the duration of labor and r educed prolonged labor; however, it did not decrease the cesarean section r ate. (C) 2001 International Federation of Gynecology and Obstetriess. All r ights reserved.