In the 2010-french perinatal survey, the overall cesarean section (CS) rate during labour was 21 % and 16% to 38% in case of dystocia. The definition of " dystocia " is traditionally based on the research led by Friedman in the 1950's on a restricted population sample. Several studies over the last years seem to indicate that the different phases of labour are longer than originally described by Friedman. Our current hypothesis is that the application of a new definition of dystocia would enable a more appropriate management of labour.
The main purpose of this study is to show a significant decrease of the CS rate with the use of the new partograph developed by Neal and Lowe. Secondary purposes are * To reduce the use of oxytocin during labour without increasing maternal or neonatal morbidity; * To decrease immediate per-operative complications and post-operative complications associated with CS
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
DIAGNOSTIC
Masking
SINGLE
Enrollment
633
The partograph designed by Neal and Lowe includes an "action line" which if crossed permits an active management of labour. Eventually, the only difference between the two arms is the moment when the active management of labour is started. The oxytocin is administrated according to the department protocol.
Classical partograph used as standard care
University Strasbourg Hospital
Strasbourg, France
Cesarean section rate (all causes)
Time frame: From admission in the labour ward to the delivery (duration from 0 to 24 hours approximately)
obstetrical measures associated with possible effects of both strategies on maternal and fetal outcome
Total amount of oxytocin used (mUI)
Time frame: From the admission in the labour ward until the dismissal from maternity (2 to 5 days)
obstetrical measures associated with possible effects of both strategies on maternal and fetal outcome
Rate of uterine hyperstimulation (%)
Time frame: From the admission in the labour ward until the dismissal from maternity (2 to 5 days)
obstetrical measures associated with possible effects of both strategies on maternal and fetal outcome
Rate of post-partum hemorrhage (%)
Time frame: From the admission in the labour ward until the dismissal from maternity (2 to 5 days)
obstetrical measures associated with possible effects of both strategies on maternal and fetal outcome
Rate of uterine rupture (%)
Time frame: From the admission in the labour ward until the dismissal from maternity (2 to 5 days)
obstetrical measures associated with possible effects of both strategies on maternal and fetal outcome
Rate of retained placenta (%)
Time frame: From the admission in the labour ward until the dismissal from maternity (2 to 5 days)
obstetrical measures associated with possible effects of both strategies on maternal and fetal outcome
Need of an artificial rupture of membranes (Y/N)
Time frame: From the admission in the labour ward until the dismissal from maternity (2 to 5 days)
obstetrical measures associated with possible effects of both strategies on maternal and fetal outcome
Color of the amniotic fluid
Time frame: From the admission in the labour ward until the dismissal from maternity (2 to 5 days)
obstetrical measures associated with possible effects of both strategies on maternal and fetal outcome
Duration of the first and second stages of labour
Time frame: From the admission in the labour ward until the dismissal from maternity (2 to 5 days)
obstetrical measures associated with possible effects of both strategies on maternal and fetal outcome
Rate of vaginal delivery (spontaneous or assisted) (%)
Time frame: From the admission in the labour ward until the dismissal from maternity (2 to 5 days)
obstetrical measures associated with possible effects of both strategies on maternal and fetal outcome
Rate of cesarean section (according to indication) (%)
Time frame: From the admission in the labour ward until the dismissal from maternity (2 to 5 days)
Maternal measures associated with possible effects of both strategies on maternal and fetal outcome
Need for an epidural or general anaesthesia
Time frame: From the admission in the labour ward until the dismissal from maternity (2 to 5 days)
Maternal measures associated with possible effects of both strategies on maternal and fetal outcome
Transfusion rate (%)
Time frame: From the admission in the labour ward until the dismissal from maternity (2 to 5 days)
Maternal measures associated with possible effects of both strategies on maternal and fetal outcome
Maternal fever during labour (°C)
Time frame: From the admission in the labour ward until the dismissal from maternity (2 to 5 days)
Maternal measures associated with possible effects of both strategies on maternal and fetal outcome
Rate of thrombo-embolic events (%)
Time frame: From the admission in the labour ward until the dismissal from maternity (2 to 5 days)
Maternal measures associated with possible effects of both strategies on maternal and fetal outcome
Rate of third- and fourth-degree perineal tears and episiotomy (%)
Time frame: From the admission in the labour ward until the dismissal from maternity (2 to 5 days)
Maternal measures associated with possible effects of both strategies on maternal and fetal outcome
Rate of surgical site infection, endometritis or septicemia (%)
Time frame: From the admission in the labour ward until the dismissal from maternity (2 to 5 days)
Neonatal measures associated with possible effects of both strategies on maternal and fetal outcome
Neonatal arterial umbilical cord pH \< 7,00 and/or BD \> 12 mmol/L
Time frame: From the admission in the labour ward until the dismissal from maternity (2 to 5 days)
Neonatal measures associated with possible effects of both strategies on maternal and fetal outcome
Apgar score \< 7 at 5 minutes
Time frame: From the admission in the labour ward until the dismissal from maternity (2 to 5 days)
Neonatal measures associated with possible effects of both strategies on maternal and fetal outcome
Transfer to intensive care unit rate
Time frame: From the admission in the labour ward until the dismissal from maternity (2 to 5 days)
Neonatal measures associated with possible effects of both strategies on maternal and fetal outcome
Neonatal infection rate (%)
Time frame: From the admission in the labour ward until the dismissal from maternity (2 to 5 days)
Neonatal measures associated with possible effects of both strategies on maternal and fetal outcome
Neonatal convulsion rate (%)
Time frame: From the admission in the labour ward until the dismissal from maternity (2 to 5 days)
Neonatal measures associated with possible effects of both strategies on maternal and fetal outcome
Rate of neonatal deaths (%)
Time frame: From the admission in the labour ward until the dismissal from maternity (2 to 5 days)
Neonatal measures associated with possible effects of both strategies on maternal and fetal outcome
Neonatal encephalopathy rate (or the introduction of therapeutic hypothermia)
Time frame: From the admission in the labour ward until the dismissal from maternity (2 to 5 days)
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.