Management of Spontaneous Labor in Primigravidae: Labor Scale versus WHO Partograph (SLiP Trial) Randomized Controlled Trial

Abstract

Objective We aimed to compare maternal and neonatal outcomes of spontaneous term labor among primigravidae who were monitored by the novel labor scale versus the World Health Organization (WHO) partograph.

Study Design A single center, double-blinded randomized trial had been conducted between July 2015 and June 2016. Nulliparous women in spontaneous labor with singleton term pregnancies were randomized to either labor scale or the WHO partograph for management of labor. Primary outcome was successful vaginal delivery. Secondary outcome included low APGAR scores, birth injuries, postpartum hemorrhage, and infection.

Results One hundred ten patients were randomized (55 in each arm). Women managed with labor scale had significantly lower rate of cesarean deliveries than women managed with the partograph arm (3.6% versus 18.2%, P=0.03). There was a significant reduction in the rate and duration of oxytocin administration for augmentation of labor (21.8% versus 69.1%, P < 0.0001) and a significant increase in average 1-minute APGAR score in the labor scale group.

Conclusion Labor monitoring with the labor scale is associated with lower rate of cesarean section, less and shorter use of oxytocin for augmentation of labor. Monitoring of labor progress starting at 5 cm or more is also associated with lower rate of cesarean delivery.

Keywords

labor dystocia - cesarean delivery - nullipara - vaginal delivery

Authors' Contributions

The study concept is of Sherif A. Shazly. The study is designed by Sherif A. Shazly, Sara M. Tolba, Ahmed M. Abbas, and Shymaa S. Ali, and it is performed by Sara M. Tolba, Armia K. Michael, Abdelrahman M. Mohammed, and Shymaa S. Ali. Analysis is done by Sherif A. Shazly, Sara M. Tolba, Ahmed M. Abbas, and Ahmed A. Nassr. The manuscript is written by Sherif A. Shazly, Ahmed A. Nassr, and Sara M. Tolba, and it is reviewed by Sherif A. Shazly, Sara M. Tolba, Shymaa S. Ali, Abdelrahman M. Mohammed, Armia K. Michael, Ahmed M. Abbas, and Ahmed A. Nassr. All authors accept responsibility for the paper as published.

Note

Study protocol was approved by the Assiut University institutional review board (IRB00008718). Informed consent was obtained after counseling women eligible for study recruitment. ClinicalTrials.gov Identifier: NCT02486822 (https://clinicaltrials.gov/ct2/show/NCT02486822).

This study was presented at the Society of Maternal-Fetal Medicine (SMFM) 37th Annual Pregnancy Meeting, Las Vegas, Nevada; January 23–28, 2017.

Funding

None.

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