Methods	RCT.
Participants	448 women in Nigeria. Inclusion criteria: nulliparous women in spontaneous labour, single fetus with cephalic presentation at term Exclusion criteria: contraindications to vaginal delivery or oxytocin augmentation, pregnancy or medical complications
Interventions	Active management group: early amniotomy was performed when labour was diagnosed, high doses of oxytocin if cervical dilatation was less than 1 cm/hour in the first stage of labour or descent was not demonstrated for 1 hour or more in second stage. Initial oxytocin infusion rate was 6mU/minute and increased by 6 mU/minute every 15 minutes to a maximum rate of 36 mU/minutes, separate labour room cared for by a nurse-midwife. Routine care: usual care, no standard protocol, there was variation among obstetricians
Outcomes	Mode of delivery; 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	Computer-generated random schedule.
Allocation concealment (selection bias)	Low risk	Opaque, sealed envelopes.
Blinding of participants and personnel (performance bias) All outcomes	High risk	The participants were not blinded to the treatment.
Blinding of outcome assessment (detection bias) All outcomes	High risk	The clinicians were not blinded to the treatment.
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Some post-randomization exclusions (11.7%).
Selective reporting (reporting bias)	Low risk	Main outcomes were reported.
Other bias	Unclear risk	Number of women eligible for recruitment were not shown.

CS: caesarean section

RCT: randomized controlled trial