Methods	RCT.
Participants	960 women in Thailand. Inclusion criteria: nulliparous women at or more than 37 weeks’ gestation; spontaneous labour; cephalic presentation; single fetus without fetal distress Exclusion criteria: thick meconium-stained amniotic fluid at admission; contraindications to vaginal delivery or oxytocin augmentation; medical or surgical complications
Interventions	Active management group: early amniotomy within 1 hour of admission, and high doses of oxytocin if cervical dilatation was less than 1 cm/hour in the first stage of labour. Initial oxytocin infusion rate was 6 mU/minute and increased by 2 mU/minute every 30 minutes to a maximum rate of 40 mU/minute. Routine care: usual care, no standard protocol, there was variation among obstetricians
Outcomes	CS; duration of labour; maternal complications and neonatal outcomes
Notes	Prevention trial. Nulliparous women.
Risk of bias
Bias	Authors’ judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Random number table.
Allocation concealment (selection bias)	Low risk	Numbered, opaque, sealed envelopes.
Blinding of participants and personnel (performance bias) All outcomes	High risk	It was impossible to blind the treatment (active management of labour) to patients
Blinding of outcome assessment (detection bias) All outcomes	High risk	The clinician was not blinded to the treatment.
Incomplete outcome data (attrition bias) All outcomes	Low risk	Some post-randomization exclusions (1.5%), but analysis by intention-to-treat
Selective reporting (reporting bias)	Low risk	Reported on main outcomes.
Other bias	Unclear risk	The management of the comparison group was not clearly described