ACTIVE

MANAGEMENT
 ACtiVe mAnAGement oF LAboR (Syn: Augmentation of
labor)
 Active management of labor was introduced by O’Driscoll
and his colleagues in 1968 at National Maternity Hospital,
Dublin.
 The term “Active” refers to the active involvement of the
consultant-obstetrician in the management of primigravid
labor.
 Active management applies exclusively to primigravidas
with singleton pregnancy and cephalic presentation who
are in spontaneous labor and with clear liquor.
 Husband or the partner is present during the course of labor
. Partograph is maintained to record the progress of labor.
 The essential components of active
management of labor (AMOL):
 Antenatal classes to explain the purpose and the
procedure of AMOL (prenatal education)
 Woman is admitted in the labor ward only after
the diagnosis of labor (regular painful uterine
contractions with cervical eff acement)
 One to one nursing care with partographic
monitoring of labor
 Amniotomy (ARM) with confi rmation of labor
 Oxytocin augmentation (escalating dose) if cervical
dilatation is <1 cm/hr.
 Delivery is completed within 12 hours of admission 
Epidural analgesia if needed
 Fetal monitoring by intermittent auscultation or by
continuous electronic monitoring
 Active involvement of the consultant obstetrician. The key
to active management involves strict vigilance (one to one
care), active and informed intervention in time. The
incidence of operative delivery is not increased and less
analgesia is required.
 AIM: To expedite delivery within 12 hours without
increasing maternal morbidity and perinatal
 Objective is —
 (a) early detection of any delay in labor;
 (b) diagnose its cause and
 (c) initiate management.
 Emotional support in labor: Stress and anxiety
during labor can make labor prolonged. Presence
of a supportive companion during labor
(husband/female relative of choice) reduces the
duration of labor, need of analgesics and oxytocin
augmentation.
 Such social support is a low cost useful
intervention. Stress-induced high levels of
endogenous adrenalin is thought to inhibit uterine
contractions via stimulation of uterine muscle beta
receptors.
 Limitations of active management of labor: It is
employed only in selected cases and in selected
centers where intensive intrapartum monitoring by
trained personnel is possible. It requires more staff
involvement in the antenatal clinic and labor ward.