RESUMO
Prospective data are presented on the outcome of labour in 67 women with uncomplicated pregnancy, who attended a rural Nicaraguan hospital and were managed actively in labour. No dystocia occurred and the caesarean section rate was 0%. Active management of labour is safe and feasible in a rural hospital setting. It results in a low caesarean section rate and reduced maternal mortality and morbidity, without compromising perinatal outcome.
PIP: 67 nulliparous women aged 20-29 delivering during a 1-year period in 1987 and 1988 were evaluated to study the incidence of cesarean section in developing countries, as this procedure is associated with high maternal mortality (1/100 operations). If cervical dilatation was less than 1 cm/hour iv oxytocin was administered. Fetal heart rate was monitored. Pudendal block anesthesia was given for forceps delivery and spinal anesthesia was administered for cesarean section. Labor lasted less than 6 hr in 26 (39%), it lasted 6-12 hr in 30 (45%), and it lasted 12 hr in 11 cases (16%). There were 6 (9%) forceps deliveries for fetal distress. In 31 (46%) women spontaneous rupture of the membranes occurred. Oxytocin was applied in 12 (18%) cases. 5 infants (7.5%) weighed less than 2500 g and 61 (91%) weighed between 2500 g and 3999 g. A regional hospital had 283 cesarean sections (12.6%) mostly for dystocia and previous cesarean over a 1-year period out 2240 births. Active management of labor reduces the use of cesarean operations. Recognition of inefficient uterine action minimizes dystocia, however, the use of oxytocin in multiparous women poses the risk of uterine rupture. A large prospective study is needed to evaluate the effect of active management of labor on the rate of cesarean sections.