For how long should oxytocin be continued during induction of labour?

Daniel-Spiegel, Etty; Weiner, Zeev; Ben‐Shlomo, Izhar; Shalev, Eliezer

doi:10.1111/j.1471-0528.2004.00096.x

Cited by 53 publications

(63 citation statements)

References 19 publications

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“…In contrast to our results, a shorter 11 or no prolongation of the active phase of labour 12,14 was found in some previous studies. However, our study supports the finding in three previous studies that the active phase is prolonged when oxytocin is discontinued during the active phase of labour.…”

Section: Discussioncontrasting

confidence: 99%

“…Despite a huge interest in oxytocin, relatively few studies have been published concerning the duration of oxytocin infusion, and the results are conflicting [10][11][12][13][14][15] (Table S1). In contrast to our results, a shorter 11 or no prolongation of the active phase of labour 12,14 was found in some previous studies.…”

Section: Discussionmentioning

confidence: 99%

“…12,14,15 Furthermore, most of the previous studies focused on the duration of the active phase of labour and rate of caesarean delivery when oxytocin was discontinued. Only two previous studies considered the association between postpartum haemorrhage 10,13 or vacuum extraction 11,13 and discontinued oxytocin. None of the previous studies investigated, as did we, the rate of third degree perineal tears when oxytocin was discontinued during the active phase.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…4 Although various oxytocin regimens for the induction or augmentation of labour have been described, [5][6][7][8][9] relatively few studies have focused on the duration of oxytocin administration in labour. [10][11][12][13][14][15] The use of oxytocin during labour may result in a number of maternal adverse effects including hypotension, tachycardia, arrhythmias, nausea, vomiting, headache and flushing. 16 Rarely, large doses of oxytocin may cause water retention, hyponatraemia, myocardial ischaemia, seizures and coma.…”

Section: Introductionmentioning

confidence: 99%

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Continuation versus discontinuation of oxytocin infusion during the active phase of labour: a randomised controlled trial

Bor

Ledertoug

Boie

et al. 2015

BJOG

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Objective To investigate whether discontinuation of oxytocin infusion increases the duration of the active phase of labour and reduces maternal and neonatal complications.Design Randomised controlled trial.Setting Department of Obstetrics and Gynaecology, Regional Hospital of Randers, Denmark.Population Women with singleton pregnancy in the vertex position undergoing labour induction or augmentation.Methods Two hundred women were randomised when cervical dilation was ≤4 cm to either continue or discontinue oxytocin infusion when cervical dilation reached 5 cm.Main outcome measures The primary outcome was duration of the active phase of labour, defined as the time period from 5 cm of cervical dilation until delivery. Secondary outcomes were mode of delivery, uterine tachysystole, hyperstimulation, abnormalities in fetal heart rate, postpartum haemorrhage rate, perineal tears, and neonatal outcomes.Results The active phase of labour was longer by 41 minutes (95% confidence interval 11-75 minutes) in the discontinued group (median 125 minutes in 85 women who had reached the active phase and delivered vaginally) versus the continued group (median 88 minutes in 78 women). The incidence of fetal heart rate abnormalities (51 versus 20%) and uterine hyperstimulation (12 versus 2%) was significantly greater in the continued than the discontinued oxytocin group. The incidence of tachysystole, caesarean deliveries, postpartum haemorrhage, third degree perineal tears and adverse neonatal outcomes was higher in the continued group, but did not reach significance.Conclusions Discontinuation of oxytocin infusion in the active phase of labour may improve some labour outcomes but has the disadvantage of increasing the duration of the active phase of labour.Keywords Active phase of labour, caesarean delivery, discontinuation of oxytocin, fetal heart rate abnormalities, hyperstimulation.Tweetable abstract Stopping oxytocin in the active phase seems to make labour less complicated but lengthens duration.Please cite this paper as: Bor P, Ledertoug S, Boie S, Knoblauch NO, Stornes I. Continuation versus discontinuation of oxytocin infusion during the active phase of labour: a randomised controlled trial. BJOG 2016;123:129-135.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Strengths and Limitationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Continuation versus discontinuation of oxytocin infusion during the active phase of labour: a randomised controlled trial

Bor

Ledertoug

Boie

et al. 2015

BJOG

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“…Data published in 2004 show that prolonged infusion of oxytocin after reaching an effective uterine contractions and the start of the active phase of labor does not bring any clear benefits (cervical dilation > 5 cm) [60].…”

Section: The Use Of Oxytocin For Labor Inductionmentioning

confidence: 99%

Polish Gynecological Society Recommendations for Labor Induction

Bomba‐Opoń¹,

Drews²,

Huras³

et al. 2017

Ginekol Pol

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Intravenous oxytocin alone for cervical ripening and induction of labour

Alfirević

Kelly

Dowswell

2009

Cochrane Database of Systematic Reviews

157

129

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Background Oxytocin is the commonest induction agent used worldwide. It has been used alone, in combination with amniotomy or following cervical ripening with other pharmacological or non-pharmacological methods. Objectives To determine the effects of oxytocin alone for third trimester cervical ripening and induction of labour in comparison with other methods of induction of labour or placebo/no treatment. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (January 2009) and bibliographies of relevant papers. Selection criteria Randomised and quasi-randomised trials comparing intravenous oxytocin with placebo or no treatment, or with prostaglandins (vaginal or intracervical) for third trimester cervical ripening or labour induction. Data collection and analysis Two review authors independently assessed eligibility and carried out data extraction. Main results Sixty-one trials (12,819 women) are included. When oxytocin inductions were compared with expectant management, fewer women failed to deliver vaginally within 24 hours (8.4% versus 53.8%, risk ratio (RR) 0.16, 95% confidence interval (CI) 0.10 to 0.25). There was a significant increase in the number of women requiring epidural analgesia (RR 1.10, 95% CI 1.04 to 1.17). Fewer women were dissatisfied with oxytocin induction in the one trial reporting this outcome (5.9% versus 13.7%, RR 0.43, 95% CI 0.33 to 0.56). Compared with vaginal prostaglandins, oxytocin increased unsuccessful vaginal delivery within 24 hours in the two trials reporting this outcome (70% versus 21%, RR 3.33, 95% CI 1.61 to 6.89). There was a small increase in epidurals when oxytocin alone was used (RR 1.09, 95% CI 1.01 to 1.17). Most of the studies included women with ruptured membranes, and there was some evidence that vaginal prostaglandin increased infection in mothers (chorioamnionitis RR 0.66, 95% CI 0.47 to 0.92) and babies (use of antibiotics RR 0.68, 95% CI 0.53 to 0.87). These data should be interpreted cautiously as infection was not pre-specified in the original review protocol. When oxytocin was compared with intracervical prostaglandins, there was an increase in unsuccessful vaginal delivery within 24 hours (50.4% versus 34.6%, RR 1.47, 95% CI 1.10 to 1.96) and an increase in caesarean sections (19.1% versus 13.7%, RR 1.37, 95% CI 1.08 to 1.74) in the oxytocin group. Authors’ conclusions Comparison of oxytocin with either intravaginal or intracervical PGE2 reveals that the prostaglandin agents probably increase the chances of achieving vaginal birth within 24 hours. Oxytocin induction may increase the rate of interventions in labour. A suggestion that for women with prelabour rupture of membranes induction with vaginal prostaglandin may increase risk of infection for mother and baby warrants further study.

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For how long should oxytocin be continued during induction of labour?

Cited by 53 publications

References 19 publications

Continuation versus discontinuation of oxytocin infusion during the active phase of labour: a randomised controlled trial

Continuation versus discontinuation of oxytocin infusion during the active phase of labour: a randomised controlled trial

Polish Gynecological Society Recommendations for Labor Induction

Intravenous oxytocin alone for cervical ripening and induction of labour

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