Early versus delayed oxytocin augmentation in nulliparous women with prolonged labour--a randomised controlled trial.

Journal article

OBJECTIVE: To study the effects of early versus delayed oxytocin augmentation on the obstetrical and neonatal outcome in nulliparous women with spontaneous but prolonged labour. DESIGN: Randomised controlled study. SETTING: Two delivery units in Sweden. POPULATION: Healthy nulliparous women with normal pregnancies, spontaneous onset of active labour, a cervical dilatation of 4-9 cm and no progress in cervical dilatation for 2 hours and for an additional hour if amniotomy was performed due to slow progress. METHODS: Women (n = 630) were randomly allocated either to labour augmentation by oxytocin infusion (early oxytocin group) or to postponement of oxytocin augmentation for another 3 hours (expectant group). MAIN OUTCOME MEASURE: Mode of delivery (spontaneous vaginal or instrumental vaginal delivery or caesarean section) and time from randomisation to delivery. RESULTS: The caesarean section rate was 29 of 314 (9%) in the early oxytocin group and 34 of 316 (11%) in the expectant group (OR 0.8, 95% CI 0.5-1.4), and instrumental vaginal delivery 54 of 314 (17%) in the early oxytocin versus 38 of 316 (12%) in the expectant group (OR 1.5, 95% CI 0.97-2.4). Early initiation of oxytocin resulted in a mean decrease of 85 minutes in the randomisation to delivery interval. CONCLUSION: Early administration of oxytocin did not change the rate of caesarean section or instrumental vaginal delivery but shortened labour duration significantly in women with a 2-hour arrest in cervical dilatation. No other clear benefits or harms were seen between early and delayed administration of oxytocin.

Authors: Dencker, A; Berg, M; Bergqvist, L; Ladfors, L; Thorsén, L

• Journal: BJOG : an international journal of obstetrics and gynaecology
• Volume: 116
• Issue: 4
• Pages: 530-536
• Publication date: 2009-03-01
• DOI: 10.1111/j.1471-0528.2008.01962.x
• EISSN: 1471-0528
• ISSN: 1470-0328
• Language: English
• Keywords: Adult; Oxytocics; Labor, Induced; Humans; Pregnancy Outcome; Female; Obstetric Labor Complications; Analgesia, Obstetrical; Oxytocin; Prospective Studies; Drug Administration Schedule; Pregnancy