Low-risk labor - outcomes after introduction of special guidelines combined with increased awareness of risk category

Objective. To study whether special guidelines for low-risk parturients combined with increased awareness of risk category affect the management of labor. Design. Hospital-based registry study. Setting. Two identical birth units in one university hospital in Oslo, Norway. Population. All low-risk parturient women in the years 20012009; a total of 28 533 deliveries. Methods. From September 2005, a special protocol for management of low-risk labors was introduced in one of the units. Data were obtained from standardized patient records, routinely recorded electronically. Outcomes were extracted for each year, and for the years 20062009 the outcomes for the two units were compared. Logistic regression was used to study factors associated with spontaneous vaginal delivery. Main outcome measures. Delivery method, use of electronic fetal monitoring, use of oxytocin, duration of labor and Apgar score at five minutes. Results. For nulliparas, the unit with special guidelines had a slightly higher rate of spontaneous vaginal deliveries (76 vs. 72.5%, p=0.006), lower use of oxytocin (48.8 vs. 56.1%, p<0.001) and electronic fetal monitoring (63.8 vs. 69.4%, p<0.001) and longer duration of labor. In multiparas, there was a small difference (15.5 vs. 18.4%, p=0.003) in the use of oxytocin. In a logistic regression, spontaneous vaginal delivery in nulliparas was negatively associated with use of oxytocin and electronic fetal monitoring, but not with the birth unit. Conclusions. A special protocol to increase awareness of risk category led to a small, although statistically significant, increase in the rate of spontaneous vaginal delivery in nulliparous, but not in parous low-risk parturients.