Discontinuing Oxytocin Infusion in the Active Phase of Labor

Saccone, Gabriele; Ciardulli, Andrea; Baxter, Jason K.; Quiñones, Joanne N.; Diven, Liany; Bor, Pınar; Maruotti, Giuseppe Maria; Martinelli, Pasquale; Berghella, Vincenzo

doi:10.1097/aog.0000000000002325

Cited by 54 publications

(35 citation statements)

References 23 publications

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“…A previous meta-analysis of nine randomized controlled trials compared continuation and discontinuation of oxytocin after the active phase of labor and its effect on labor induction and labor augmentation [7][8][9][10][11][12][13][14][15]24]. In that meta-analysis, oxytocin discontinuation after the active phase of labor signi cantly lowered the cesarean delivery rate (9.3% vs 14.7%) and uterine tachysystole rate (6.2% vs 13.1%) compared with oxytocin continuation until delivery [24]. When labor enters the active phase, further oxytocin administration does not seem to have any bene t except for shortening the labor length.…”

Section: Discussionmentioning

confidence: 99%

Oxytocin Discontinuation During Induced Labor in Pregnancies With Suspected Fetal Growth Restriction

Iwai¹,

Mimura²,

Endo³

et al. 2020

Preprint

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Objective: Although fetal growth restriction (FGR) is associated with an increased risk of cesarean delivery during induced labor, there is little evidence to guide labor management in such cases. This study aimed to investigate whether discontinuation of oxytocin infusion affects the cesarean delivery rate and the risk of maternal and neonatal complications associated with induced labor in pregnancies with suspected FGR.Methods: This was a retrospective cohort study of singleton pregnancies with vertex presentation and indications for labor induction due to FGR after 34.0 weeks of gestation at our institution from January 2010 to December 2017. Two parallel groups were compared: women who received oxytocin continuously until delivery (continuation group) and women whose oxytocin was discontinued at the beginning of the active phase of labor (discontinuation group).Results: There were 74 women in the continuation group and 51 women in the discontinuation group. The incidence of cesarean deliveries was higher (5.4% vs 2.0%) in the continuation group, but this difference was not statistically significant. However, the incidence of uterine tachysystole (23.0% vs 9.8%) was significantly higher in the continuation group than in the discontinuation group. Differences in labor management did not affect the lengths of the active phase and second stage of labor (mean, 136 ± 122 minutes and 34.2 ± 45 minutes, respectively; 122 ± 104 minutes and 48.8±67 minutes in the continuation group and discontinuation group, respectively). The incidence of postpartum hemorrhage and adverse neonatal outcomes were not significantly different between groups.Conclusions: Oxytocin can be safely discontinued after the active phase of labor in women undergoing labor induction for FGR without an increased risk of cesarean delivery or other unfavorable outcomes. Therefore, this strategy may be considered an alternative to continued oxytocin infusion.

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Section: Discussionmentioning

confidence: 99%

Oxytocin Discontinuation During Induced Labor in Pregnancies With Suspected Fetal Growth Restriction

Iwai¹,

Mimura²,

Endo³

et al. 2020

Preprint

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“…non-progression of the cervical dilation during the latent phase [9][10][11]. One assumption is that, once women requiring oxytocin during the latent phase enter the active phase, natural oxytocin takes over from synthetic oxytocin [12]. Thus, in the active phase, oxytocin could be discontinued, reducing exposure duration and therefore reducing the risk of complications, in particular neonatal complications such as hypoxia, without compromising the chances of vaginal delivery.…”

Section: (Continued From Previous Page)mentioning

confidence: 99%

“…All these studies but one [15] were randomized, none used blinding, and the largest sample size was of 342 women (168 vs 174) [16]. Most of these studies, as well as the metanalysis [12] including them, showed a longer length of active phase of labor in the discontinuation of oxytocin group (in the metanalysis the mean difference was 27.65 min, 95%CI 3.94-51.36). None of these previous published trials, nor the meta-analysis combining these trials [12] showed an increase in the cesarean delivery rate in the discontinuous oxytocin group, on the contrary, the meta-analysis showed a significant decrease in the cesarean delivery rate in the discontinuous oxytocin group (9.3% compared with 14.7%; RR 0.64, 95%CI 0.48-0.87).…”

Section: Previous Published Studiesmentioning

confidence: 99%

“…Indeed, some of the previous studies showed that during the active phase of labor, 30 to 40% of the women with a discontinued administration of oxytocin required a re-start of oxytocin after a two-hour arrest of labor [14,15]. Another situation requiring to un-blind the randomization group is in case of non-reassuring fetal heart rate which was the case in up to 8% of the women in Saccones' metanalysis [12]. Indeed, in the context of non-reassuring fetal heart rate (FHR) it is important for the obstetrician to know the treatment group in order to stop the oxytocin infusion to reduce uterine contractility.…”

Section: Choice Of Open-label Designmentioning

confidence: 99%

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Reducing neonatal morbidity by discontinuing oxytocin during the active phase of first stage of labor: a multicenter randomized controlled trial STOPOXY

Girault

Goffinet

Ray

2020

BMC Pregnancy Childbirth

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Background Oxytocin is effective in reducing labor duration, but can be associated with fetal and maternal complications such as neonatal acidosis and post-partum hemorrhage. When comparing discontinuing oxytocin in the active phase with continuing oxytocin infusion, previous studies were underpowered to show a reduction in neonatal morbidity. Thus, we aim at evaluating the impact of discontinuing oxytocin during the active phase of the first stage of labor on the neonatal morbidity rate. Methods STOPOXY is a multicenter, randomized, open-label, controlled trial conducted in 20 maternity units in France. The first participant was recruited January 17th 2020. The trial includes women with a live term (≥37 weeks) singleton, in cephalic presentation, receiving oxytocin before 4 cm, after an induced or spontaneous labor. Women aged < 18 years, with a lack of social security coverage, a scarred uterus, a multiple pregnancy, a fetal congenital malformation, a growth retardation <3rd percentile or an abnormal fetal heart rate at randomization are excluded. Women are randomized before 6 cm when oxytocin is either continued or discontinued. Randomization is stratified by center and parity. The primary outcome, neonatal morbidity is assessed using a composite variable defined by an umbilical arterial pH at birth < 7.10 and/or a base excess > 10 mmol/L and/or umbilical arterial lactates> 7 mmol/L and/or a 5 min Apgar score < 7 and/or admission in neonatal intensive care unit. The primary outcome will be compared between the two groups using a chi-square test with a p-value of 0.05. Secondary outcomes include neonatal complications, duration of active phase, mode of delivery, fetal and maternal complications during labor and delivery, including cesarean delivery rate and postpartum hemorrhage, and birth experience. We aim at including 2475 women based on a reduction in neonatal morbidity from 8% in the control group to 5% in the experimental group, with a power of 80% and an alpha risk of 5%. Discussion Discontinuing oxytocin during the active phase of labor could improve both child health, by reducing moderate to severe neonatal morbidity, and maternal health by reducing cesarean delivery and postpartum hemorrhage rates. Trial registration Clinical trials NCT03991091, registered June 19th, 2019.

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“…Cochrane veri tabanında yapılan bir derlemede; erken dönemde oksitosin uygulamasının sezaryen doğum oranlarında orta derecede bir azalmaya neden olduğu ve doğum süresini kısalttığı belirtilmiştir (26). Ancak doğumun aktif fazından sonra oksitosin uygulamasına devam edilen ve edilmeyen grupların karşılaştırıldığı, dokuz araştırmanın değerlendirildiği bir meta-analiz çalışmasında; oksitosin infüzyonuna devam edilen grupta sezaryen ve uterin taşisistoli riskinin arttığı belirtilmiştir (43). Yine bazı çalışmalarda oksitosin kullanımının maternal ve neonatal yan etkilere neden olduğu belirtilmiştir.…”

Section: Forseps Ve Vakumunclassified

Effect of type of birth on the health of mother and newborn

Erenel

Çiçek

2018

Süleyman Demirel Üniversitesi Sağlık Bilimleri Dergisi

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There are many short-term and long-term effects of interventions in the childbirth on the health of both mother and child. In recent years, it has been observed that there is a significant increase in the rate of interventional birth methods. Breeding intervention, if it is necessary, can be life saving for mother and child. On the other hand, any kind of intervention in the childbirth moves the birth away from its nature. Nowadays, the most common interventions to chilbirth are episiotomy, amniotomy, oxytocin induction, and cesarean birth. In order to perform the birth safely in the presence of fetal and maternal indications, it is inevitable to use these methods. However, it has been suggested in the conducted studies that the interventions to childbirth causes cause many complications in the mother and the child. As a result, interventions in childbirth should be avoided unless there is a medical obligation in terms of maternal and child health. The nature of birth and the preferences of the woman must be respected.

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Discontinuing Oxytocin Infusion in the Active Phase of Labor

Cited by 54 publications

References 23 publications

Oxytocin Discontinuation During Induced Labor in Pregnancies With Suspected Fetal Growth Restriction

Oxytocin Discontinuation During Induced Labor in Pregnancies With Suspected Fetal Growth Restriction

Reducing neonatal morbidity by discontinuing oxytocin during the active phase of first stage of labor: a multicenter randomized controlled trial STOPOXY

Effect of type of birth on the health of mother and newborn

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