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High-dose versus low-dose of oxytocin for labour augmentation: a randomised controlled trial
Univ Gothenburg, Sahlgrenska Acad, Inst Hlth & Care Sci, S-40530 Gothenburg, Sweden;NU Hosp Grp, Dept Obstet & Gynecol, Trollhattan, Sweden.
Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Dept Obstet & Gynecol, Gothenburg, Sweden.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Obstetrics.
Univ Gothenburg, Sahlgrenska Acad, Inst Hlth & Care Sci, S-40530 Gothenburg, Sweden;Univ Gothenburg, Sahlgrenska Acad, Ctr Person Ctr Care, Gothenburg, Sweden.
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2019 (English)In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 32, no 4, p. 356-363Article in journal (Refereed) Published
Abstract [en]

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 (-23.4 min); 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. 

Place, publisher, year, edition, pages
ELSEVIER , 2019. Vol. 32, no 4, p. 356-363
Keywords [en]
Augmentation of labour, Delayed labour, Oxytocin, Caesarean, Nulliparous
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
URN: urn:nbn:se:uu:diva-390491DOI: 10.1016/j.wombi.2018.09.002ISI: 000475555500018PubMedID: 30341003OAI: oai:DiVA.org:uu-390491DiVA, id: diva2:1341932
Available from: 2019-08-12 Created: 2019-08-12 Last updated: 2019-08-12Bibliographically approved

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