Cluster RCT on decision aid to diagnosis active labour in pregnancy

A cluster randomised trial to investigate the use of a decision aid for the diagnosis of active labour in term pregnancy

Admission of women who are not in labour accounts for 10% to 30% of maternity admissions. This is an unnecessary burden on resources. Women admitted in latent labour have the appearance of a longer labour and are more likely to receive a cascade of intervention starting with administration of oxytocin and including caesarean section. A previous study developed and tested a decision aid for diagnosis of active labour and assessed the feasibility of conducting a cluster randomised trial. This study went on to conduct the cluster randomised controlled trial, recruiting twelve maternity units with an average cluster size of 200 women, with units randomly allocated to receive either the decision aid or standard care. Outcomes included use of oxytocin, interventions and analgesia in labour, mode of delivery. NHS costs and costs to women were also assessed.

Outcome and Translation

This was the largest ever randomised controlled trial of an initiative aimed at reducing early admissions to the labour ward. However, the proposed algorithm was not effective in changing use of resources or improving outcomes. As a result there are no plans to implement the algorithm. Future initiatives to reduce early admission to the labour ward need to focus on the perspectives of women as well as those of clinicians.

HERU researchers involved in this research project: Paul McNamee and Graham Scotland

External Collaborators: H Cheyne, C Niven (University of Stirling); V Hundley (University of Stirling & Aberdeen); D Dowding, M Bland, (University of York); I Greer (University of Glasgow) and L Aucott (Department of Population Health, University of Aberdeen)

Publications

Cheyne, H., Terry, R., Niven, C., Dowding, D., Hundley, V. and McNamee, P. (2007) 'Should I come in now? A study of women's early labour experiences', British Midwifery Journal, 15(10), 604-625.

Cheyne, H., Hundley, V., Dowding, D., Niven, C., Greer, I., Bland, JM., Aucott, L. and McNamee, P. (2007) 'A cluster randomised trial to investigate the use of a decision aid for the diagnosis of active labour in term pregnancy (The Early Labour Study in Scotland)', Chief Scientist Office Final Report.

Cheyne, H., Hundley, V., Dowding, D., Bland, J.M., McNamee, P., Greer, I.A., Styles, M., Barnett, C.A., Scotland, G.S. and Niven, C.A. (2008) 'Effects of algorithm for diagnosis of active labour: a cluster randomised trial', British Medical Journal, 337 (7683), a2396.

Scotland, G., McNamee, P., Cheyne, H., Hundley, V. and Barnett, C. (2011) 'Women's preferences for aspects of labor management: results from a discrete choice experiment', Birth-Issues in Perinatal Care, 38(1), 36-46.

Presentations

Cheyne, H., Hundley, V., Dowding, D., Aucott, L., McNamee, P.,Styles, M., Barnett. CA., Greer, I., Bland, M. and Niven, K. (2008) 'The Early Labour Study in Scotland: measuring the benefits of an algorithm for diagnosis of active labour using discrete choice experiments', Triennial International Confederation of Midwives Congress, Glasgow, 2008.

Cheyne, H. and McNamee, P. (2008) 'The early labour study in Scotland: TELSIS,' Dugald Baird Centre, University of Aberdeen, 2008.

Scotland, G. and McNamee, P. (2008) 'Measuring the benefits of an algorithm for diagnosis of active labour: results from a discrete choice experiment (DCE). The Early Labour Study in Scotland (TELSiS) Symposium, Congress of the International Confederation of Midwives, Glasgow, June 2008.

Scotland, G., McNamee, P. and Ryan, M. (2008) 'Should we be concerned about learning effects in discrete choice experiments?' European Conference on Health Economics, University of Rome, July 2008.