Proactive versus standard support of labor in the latent phase – A randomized, controlled clinical trial

Abstract

Objective

Long latent phase of labor with subsequent prolonged total labor duration increases the risk of obstetric interventions and complications. We explored whether Proactive Support of Labor (PSL) compared to Standard Support of Labor (SSL) in the latent phase, reduces the rate of complicated deliveries in nulliparous women.

Design

Randomized, controlled trial (RCT).

Methods

A single-center RCT, at St. Olav’s University Hospital of Trondheim, Norway, including 356 nulliparous women in the latent phase of labor with a singleton pregnancy, cephalic presentation and spontaneous term onset of labor.

Main outcome measures

The composite rate of complicated deliveries, defined as instrumental delivery, caesarean section (CS), estimated blood loss >500  ml, intrapartum temperature >38.0⁰ °C, shoulder dystocia, perineal laceration grade III or IV, or Apgar score <7 at 5  min.

Results

We found no difference in the composite rate of complicated deliveries, 40 % vs 34 % respectively, (OR = 1.3 (95 % CI = 0.8–2.0), p-value = 0.302), or the individual components of complicated deliveries, between PSL and SSL groups. In the PSL group, both the duration of labor and the individual maximum dosage of oxytocin were reduced. The number of vaginal examinations and transfer to neonatal intensive care unit in the PSL and SSL groups were similar. More women in the PSL group received epidural analgesia.

Conclusion

Proactive support of labor in the latent phase did not reduce the rate of complicated deliveries, but shortened labor duration, with lower maximum oxytocin dosage. Proactive support of labor may be considered as an alternative option for some nulliparous women to prevent a long latent phase of labor, without compromising maternal or newborn safety.