PATIENT CONTROLLED LABOUR MONITORING: A NOVEL APPROACH TO LABOUR MANAGEMENT

Abstract

This study is aimed to determine the reliability, accuracy and safety of patients’ self
monitoring of uterine contractions and other aspects of their labor like fetal heart rate
counting, and liquor color assessment during their labor in a supervised setting in order to
achieve greater self-control over their intrapartum management.
It is prospective, randomized controlled trial of self-monitoring of labour versus
conventional labour monitoring.
One hundred and eleven consenting low-risk parturients that have been well informed,
counseled and trained about monitoring of labor during antenatal period who presents for
labor and delivery were randomized to either arm.. A total of 55 and 56 parturient were in
self-monitoring and conventional groups respectively..
The accuracy of self-monitoring, delivery, neonatal outcomes and maternal satisfaction were
main outcome.
The two groups were comparable with respect to demographic characteristic. Overall, more
than half of the women randomized to the self-monitoring group were able to accurately
monited those aspect of labour required of them. More interestly, more than 90% of women
currectly measured their uterine contraction frequency and duration, timing of their next
assessment and the liquor colour. Self-monitoring resulted in tendency towards reduction in
duration of labour (geometric mean: self-monitored 597 min vs conventional, 612 min; ratio
of geometric means 0.98, 95 % confidence interval 0.93 to 1.03), but no clinically important
difference.
Self-monitored labour is associated shorter and significant reduction in pain score on visual
analogue scale (P<0.001). There was no significant difference in the rate of spontaneous
vaginal delivery 35(66%) versus 36 (66.7%), the caesaream delivery rate (22.6% versus 25.9%; odd ratio 0.84, 0.34 to 2.03), or the rate of instrumental vaginal delivery (11.3%
versus 7.4%)
Neonatal outcomes were also similar.
Maternal satisfaction and feeling of ha ving control of labour management were higher in the
self-monitored group. The overall satisfaction rate in the group revealed that, and more than
three-quarters of the health workers in self-monitoring were favourably disposed to it
In conclusion, self-monitoring of labour is feasible, and is associated with reduced
labour pain experience, improved maternal satisfaction with labour management, without
increasing intrapartum maternal or neonatal complications.

PATIENT CONTROLLED LABOUR MONITORING: A NOVEL APPROACH TO LABOUR MANAGEMENT