Active management is associated with small reductions in the CS rate, but it is highly prescriptive and interventional. It is possible that some components of the active management package are more effective than others. Further work is required to determine the acceptability of active management to women in labour.
Active management of labour in a district hospital setting.
The aim of this randomised trial was to determine the effect of the policy of active management of labour in all its components on the rate of caesarean section in a Nigerian district hospital setting. Two hundred and twenty-one nulliparous women fulfilling selected inclusion criteria were randomised to receive active management of labour, and 227 control women received routine labour management. Labour was significantly shortened by over 2 hours with active management of labour, and caesarean section reduced (9% vs. 16%, RR 0.57, 95% CI 0.34-0.95). There were no significant differences in maternal infectious morbidity, uterine hyperstimulation syndromes, ruptured uterus or neonatal Apgar scores between the two groups. We conclude that active management of labour shortens primigravid labour and reduces caesarean risk.