An investigation into the feasibility of comparing three management options (augmentation, conservative and water) for nulliparae with dystocia in the first stage of labour

Objective: to evaluate the feasibility of a randomised controlled trial (RC T) examining the effect of three options (augmentation, conservative and wa ter) for the management of dystocia in nulliparae. The main objectives were to explore the feasibility of trial procedures in the clinical environment , consent rates and acceptability of the management options to women, local incidence of dystocia in nulliparae and the size of the subsequent study. Design: a two part study: a pilot, RCT with follow-up through to delivery w ith postnatal maternal surveys, and a case review of nulliparae with dystoc ia, Setting: a large maternity unit in the South of England in May-July 1997 in clusive. Participants: nulliparae with dystocia in the first stage of labour who had an otherwise uncomplicated obstetric background. Interventions: women in the pilot RCT received one of three management opti ons: labouring in a waterbirth pool, conservative management or augmentatio n of labour, which is the standard management of women with dystocia condit ion in the Unit. Findings: it is feasible to conduct an RCT of management of dystocia in the Unit. Seventy per cent (95% confidence interval 47% to 87%) of women appro ached agreed to participate. Conservative management was the least acceptab le option to women and has been dropped from the subsequent trial. The audi t provided some idea of possible differences in operative delivery and epid ural rates depending on augmentation or not. A sample of 220 women should b e large enough to detect moderate changes and will require a 2-year recruit ment period. Conclusions: a subsequent trial is feasible and is now underway. It has the potential to provide information enabling women and practitioners to have a greater choice of care options in the presence of dystocia, or provide a good basis for an even larger trial. (C) 2000 of Harcourt Publishers Ltd.