High-dose versus low-dose of oxytocin for labour augmentation: a randomised controlled trial.

Abstract

PROBLEM:

Delayed labour progress is common in nulliparous women, often leading to caesarean section despite augmentation of labour with synthetic oxytocin.

BACKGROUND:

High- or low-dose oxytocin can be used for augmentation of delayed labour, but evidence for promoting high-dose is weak. Aim To ascertain the effect on caesarean section rate of high-dose versus low-dose oxytocin for augmentation of delayed labour in nulliparous women. Methods Multicentre parallel double-blind randomised controlled trial (ClinicalTrials.gov: NCT01587625) in six labour wards in Sweden. Healthy nulliparous women at term with singleton cephalic fetal presentation, spontaneous labour onset, confirmed delay in labour and ruptured membranes (n=1351) were randomised to labour augmentation with either high-dose (6.6 mU/minute) or low-dose (3.3 mU/minute) oxytocin infusion.

FINDINGS:

1295 women were included in intention-to-treat analysis (high-dose n=647; low-dose n=648). Caesarean section rates did not differ between groups (12.4% and 12.3%, 95% Confidence Interval -3.7 to 3.8). Women with high-dose oxytocin had: shorter labours (-23.4min); more uterine tachysystole (43.2% versus 33.5%); similar rates of instrumental vaginal births, with more due to fetal distress (43.8% versus 22.7%) and fewer due to failure to progress (39.6% versus 58.8%). There were no differences in neonatal outcomes.

DISCUSSION:

Our study could not confirm results of two systematic reviews indicating, with weak evidence, that use of high-dose oxytocin was associated with lower frequency of caesarean section.

CONCLUSION:

We found no advantages for routine use of high-dose oxytocin in the management of delay in labour. Low-dose oxytocin regimen is recommended to avoid unnecessary events of tachysystole and fetal distress.

• Authors: Lotta Selin, Ulla-Britt Wennerholm, Maria Jonsson, Anna Dencker, Gunnar Wallin, Eva Wiberg-Itzel, Elisabeth Almström, Max Petzold, Marie Berg
• Journal: Women and birth : journal of the Australian College of Midwives (Women Birth) Vol. 32 Issue 4 Pg. 356-363 (Aug 2019) ISSN: 1878-1799 [Electronic] Netherlands
• PMID: 30341003 (Publication Type: Journal Article, Randomized Controlled Trial)
• Copyright: Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

Chemical References

• Oxytocics
• Oxytocin

Topics

• Adult
• Cesarean Section (statistics & numerical data)
• Double-Blind Method
• Female
• Fetal Distress (chemically induced)
• Humans
• Labor Presentation
• Labor, Induced (methods)
• Oxytocics (administration & dosage)
• Oxytocin (administration & dosage)
• Pregnancy
• Sweden
• Treatment Outcome