A randomized trial of labor augmentation by oxytocin vs delayed oxytocin treatment or no oxytocin in nulliparous women with spontaneous contractions

• Objective To study the effects of oxytocin treatment vs. no or delayed oxytocin treatment on the obstetrical and neonatal outcome of spontaneous but prolonged labor in nulliparous women. Study design A randomized controlled study of healthy nulliparous women at term with normal pregnancies and spontaneous labor. If labor was prolonged during the active phase with no further opening of the cervix or descent of the head for two hours the women were randomly allocated to either labor augmentation by oxytocin infusion (standard care group= SG) or to expectancy (Expectant care group=EG) and observed for another 3 hours. If the women in the EG after the 3 hours still do not progress in their labor, a reassessment regarding the need for labor augmentation was done. Results Totally 516 women participated in the study, 276 in the SG and 241 in the EG. All 241 women in the SG received oxytocin vs 211 (87.6%) in the EG (p<0,001). There were no differences in gestational age between the groups. Mean gestational age was 40 weeks in both groups. There were no difference in cervical dilatation at randomization, cx dilatation in centimeters was 5,7 (SD1,5) in the SG vs 5,5 (SD 1,3), p= 0.17 in the EG. The time from randomization to delivery differed, 332 (SD=211) minutes in the SG vs 457 (SD=238) minutes in the EG (p <.0001). There was no differences in mode of delivery, Caesarean sectio 23 (8,3%) in the SG vs 21 (8,7%) in the EG, (p=0.9), operative vaginal delivery 44 (15,9%) SG vs 25 (10,4%) EG p=0.07, Spontaneous vaginal delivery 209 (75,7%) SG vs 195 (80,9%) EG p=0.2,. Usage of epidural anesthesia was 29 (10,5%) SG vs 39 (16,2%) EG p=0.07. Apgar score below 7 after 5 minutes was found in 5 (1.8%) in SG vs 9 (3.7%) in EG. Conclusion In nulliparous women at term with spontaneous contractions a policy of delaying the initiation of oxytocininfusion in prolonged active phase for 180 minutes resulted in no difference in mode of delivery, usage of epidural anesthesia or neonates with apgar score below 7 at 5 minutes. The time from randomization to delivery differed by 125 minutes.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Reproduktionsmedicin och gynekologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Obstetrics, Gynaecology and Reproductive Medicine (hsv//eng)

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