Effect of the WHO labour care guide on cesarean delivery and intrapartum interventions: a randomized controlled trial

Background: The World Health Organization (WHO) Labour Care Guide (LCG) promotes individualized intrapartum care. This trial compared caesarean delivery and maternal and neonatal outcomes among women monitored with the LCG versus the modified partograph. Methods: In this single-center randomized controlled trial, 266 low-risk women with singleton, term, cephalic pregnancies in spontaneous labour were allocated to LCG or modified-partograph monitoring (133 per group). The primary outcome was caesarean delivery. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated for binary outcomes. Results: Caesarean delivery occurred in 41/133 (30.8%) women in the LCG group and 39/133 (29.3%) in the modified-partograph group (RR 1.05, 95% CI 0.73-1.52; P=0.894). Active labour was longer with the LCG (mean difference 1.4 hours, 95% CI 0.92-1.88; P<0.001). Oxytocin augmentation (18.0% vs 39.1%; RR 0.46, 95% CI 0.30-0.70) and amniotomy (6.0% vs 55.6%; RR 0.11, 95% CI 0.05-0.22) were less frequent with the LCG (both P<0.001). Neonatal intensive care unit admission was similar (16.5% vs 19.5%; P=0.633). Conclusions: The LCG did not reduce caesarean delivery but was associated with fewer intrapartum interventions and longer active labour, without evidence of worse short-term neonatal outcomes.