This document summarizes the components and goals of active management of labor (AML) for primigravid women. AML aims to expedite delivery within 12 hours without increasing risks. It involves prenatal education, early admission upon labor diagnosis, one-to-one nursing care with monitoring, amniotomy, oxytocin augmentation if needed, epidural analgesia if required, and active obstetrician involvement. The objective is early detection and management of any labor delays. AML can reduce dysfunctional labor, shorten duration, detect fetal hypoxia early and lower cesarean rates while reducing maternal anxiety and need for analgesia. However, it requires intensive monitoring and more staff.

1. AUGMENTATION OF LABOUR
- DR. SUPRIYA MAHIND

2. AUGMENTATION OF LABOUR
(ACTIVE MANAGEMENT OF LABOUR)
 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.

3. ESSENTIAL COMPONENTS FOR ACTIVE
MANAGEMENT OF LABOUR (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 effacement)
• One to one nursing care with partographic
monitoring of labor
• Amniotomy (ARM) with confirmation of labor

4. • 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.

5. Aim:
To expedite delivery within 12 hours without increasing
maternal morbidity and perinatal hazards.
Active management of labor:
Objective is — (a) early detection of any delay in labor
(b)diagnose its cause and
(c) initiate management.

6. Contraindications are:
• Presence of obstetric complication
• Presence of fetal compromise
• Multigravida (not a routine)

7. Advantages are:
• Less chance of dysfunctional
labor
• Shortens the duration of
labor (< 12 hours)
• Fetal hypoxia can be detected
early
• Low incidence of cesarean
birth
• Less analgesia
• Less maternal anxiety due to support of the caregiver
and prenatal education.

8.  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.

9. 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.

10. Thank you