Effect of intra-partum Oxytocin on neonatal encephalopathy: a systematic review and meta-analysis

Abstract

Background Oxytocin is widely used for induction and augmentation of labour, particularly in low- and middle-income countries (LMICs). In this systematic review and meta-analysis, we examined the effect of intra-partum Oxytocin use on neonatal encephalopathy. Methods The protocol for this study was registered with PROSPERO (ID: CRD42020165049). We searched Medline, Embase and Web of Science Core Collection databases for papers published between January 1970 and May 2021. We considered all studies involving term and near-term (≥36 weeks’ gestation) primigravidae and multiparous women. We included all randomised, quasi-randomised clinical trials, retrospective studies and non-randomised prospective studies reporting intra-partum Oxytocin administration for induction and/or augmentation of labour. Our primary outcome was neonatal encephalopathy. Risk of bias was assessed in non-randomised studies using the Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I) tool. The RoB 2.0 tool was used for randomised studies. A Mantel-Haenszel statistical method and random effects analysis model were used for meta-analysis. Odds ratios were used to determine effect measure and reported with 95% confidence intervals. Results We included data from seven studies (6 Case-control studies, 1 cluster-randomised trial) of which 3 took place in high-income countries (HICs) and 4 in LMICs. The pooled data included a total of 24,208 women giving birth at or after 36 weeks; 7642 had intra-partum Oxytocin for induction and/or augmentation of labour, and 16,566 did not receive intra-partum Oxytocin. Oxytocin use was associated with an increased prevalence of neonatal encephalopathy (Odds Ratio 2.19, 95% CI 1.58 to 3.04; p < 0.00001). Conclusions Intra-partum Oxytocin may increase the risk of neonatal encephalopathy. Future clinical trials of uterotonics should include neonatal encephalopathy as a key outcome.

Predictive accuracy of admission cardiotocography as a screening tool for perinatal asphyxia in high‐risk parturients in Northern Nigeria

“…Augmentation of labor was found to be an independent predictor of perinatal outcome. Similarly, a recent review by Burgod et al, 26 found intra-labor use of oxytocics to be associated with neonatal encephalopathy. Therefore, augmentation of labor must be done with caution.…”

Labor augmentation with oxytocin in low- and lower-middle-income countries: a systematic review and meta-analysis

“…This is in line with observational studies from high-income countries, but with more severe consequences. 6 , 7 , 8 , 62 , 63 Suboptimal monitoring of FHR and contractions, as described in the studies, is likely mediating the severity of risks. The influence of substandard care was, however, not assessed in the studies.…”

“… 1 Observational studies, from high-income countries mainly, suggest an association with acidemia, low Apgar score, and neonatal encephalopathy (NE). 6 , 7 , 8 …”

Whole-Body Hypothermia, Cerebral Magnetic Resonance Biomarkers, and Outcomes in Neonates With Moderate or Severe Hypoxic-Ischemic Encephalopathy Born at Tertiary Care Centers vs Other Facilities

“…Hence, brain injury might occur from intermittent cerebral hypoxia during active labor, especially if labor is medically augmented 41 -"vulnerable baby in the womb." Preclinical models of growthrestricted animals and intermittent umbilical cord occlusion 42 may represent this scenario.…”