Intended for healthcare professionals


Effects of algorithm for diagnosis of active labour: cluster randomised trial

BMJ 2008; 337 doi: (Published 08 December 2008) Cite this as: BMJ 2008;337:a2396
  1. Helen Cheyne, research programme leader1,
  2. Vanora Hundley, honorary senior lecturer1,
  3. Dawn Dowding, senior lecturer23,
  4. J Martin Bland, professor of health statistics2,
  5. Paul McNamee, senior research fellow4,
  6. Ian Greer, dean3,
  7. Maggie Styles, lecturer5,
  8. Carol A Barnett, senior midwife6,
  9. Graham Scotland, research fellow4,
  10. Catherine Niven, director1
  1. 1Nursing Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling FK9 4LA
  2. 2Department of Health Sciences, University of York, York YO10 5DD
  3. 3Hull York Medical School, University of York
  4. 4Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZD
  5. 5Department of Nursing and Midwifery, University of Stirling
  6. 6NHS Tayside, Kings Cross Hospital, Dundee DD3 8EA
  1. Correspondence to: H Cheyne h.l.cheyne{at}
  • Accepted 9 September 2008


Objective To compare the effectiveness of an algorithm for diagnosis of active labour in primiparous women with standard care in terms of maternal and neonatal outcomes.

Design Cluster randomised trial.

Setting Maternity units in Scotland with at least 800 annual births.

Participants 4503 women giving birth for the first time, in 14 maternity units. Seven experimental clusters collected data from a baseline sample of 1029 women and a post-implementation sample of 896 women. The seven control clusters had a baseline sample of 1291 women and a post-implementation sample of 1287 women.

Intervention Use of an algorithm by midwives to assist their diagnosis of active labour, compared with standard care.

Main outcomes Primary outcome: use of oxytocin for augmentation of labour. Secondary outcomes: medical interventions in labour, admission management, and birth outcome.

Results No significant difference was found between groups in percentage use of oxytocin for augmentation of labour (experimental minus control, difference=0.3, 95% confidence interval −9.2 to 9.8; P=0.9) or in the use of medical interventions in labour. Women in the algorithm group were more likely to be discharged from the labour suite after their first labour assessment (difference=−19.2, −29.9 to −8.6; P=0.002) and to have more pre-labour admissions (0.29, 0.04 to 0.55; P=0.03).

Conclusions Use of an algorithm to assist midwives with the diagnosis of active labour in primiparous women did not result in a reduction in oxytocin use or in medical intervention in spontaneous labour. Significantly more women in the experimental group were discharged home after their first labour ward assessment.

Trial registration Current Controlled Trials ISRCTN00522952.


  • We thank the midwives and mothers who participated in or facilitated this study.

  • Contributors: HC was involved in study and tool design; project management; and data collection, analysis, and interpretation. VH, DD, and CN were involved in study and tool design and interpretation of data. JMB was involved in study design, group allocation, and data analysis and interpretation. PMcN was involved in study design, health economics tool design, and data analysis. IG was involved in study design and interpretation of data. MS and CAB were involved in tool design and data collection, entry, and interpretation. GS was involved in health economics tool design and data analysis. HC is the guarantor.

  • Local principal investigators, responsible for the conduct of the trial at the individual sites: Angela Watt, Annette Lobo, Susan Stewart, Angela Cunningham, Joyce Linton, Carol Powrie, Gillian Morton, Cathy Harkins, Lynn Wojciechowska, Joan Milne, Eleanor Stenhouse, Lorraine Wilson, and Liz Terrace.

  • Local trial coordinators, who supported the trial locally and collected trial outcome data: Morag Grant, Anne Paterson, Sylvia Morrison, Gillian McMurray, Alison Hourston, Liz McMurchie, Lesley Darroch, Fiona Mundell, Caron Cruikshank, Liz Main, Carol Beatts, Anne Marie Brolly, Karen McIntosh, Bernie McStea, and Janie Cunning.

  • Sponsor: The University of Stirling was the study sponsor. The sponsor had no role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.

  • Funding: This work was supported by the Scottish Executive Chief Scientist Office Health Service Research Committee (CZH/4/245). The research was independent of the funders.

  • Competing interests: None declared.

  • Ethical approval: The Multicentre Research Ethics Committee for Scotland B approved the study (05/MRE10/31). The local research ethics committees in each area granted site specific approval. All women gave informed consent.

  • Provenance and peer review: Not commissioned; externally peer reviewed.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

View Full Text