Active management of labor associated with a decrease in the cesarean section rate in nulliparas.

Active management of labor was introduced as the standard policy for the care of nulliparas in labor in a London maternity hospital. The basis of this management is, first, a strict diagnosis of labor and second, the early diagnosis and prompt treatment of dystocia. This study describes the outcome in 1000 consecutive nulliparas who were actively managed. In this multiracial population, active management was associated with a decrease in the cesarean section rate, without any evidence of an increase in perinatal mortality or morbidity. The results indicate that active management can be safely applied outside of Ireland to reduce the incidence of cesarean childbirth. It is suggested that this approach to the management of dystocia in labor be evaluated in the United States in a randomized controlled trial.