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

Abstract

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.

Continuation versus Discontinuation of Oxytocin in Active Phase of Labour- A Randomised Trial

“…In contrary, study by Bor P et al 8 found the active phase of labour to be longer by 41 minutes in the discontinue group (Median 125 minutes) than in the continued group ( median 88 minutes), p value being 0.007 means significant difference.…”

Oxytocin Discontinuation During Induced Labor in Pregnancies With Suspected Fetal Growth Restriction

“…A previous meta-analysis of nine randomized controlled trials compared continuation and discontinuation of oxytocin after the active phase of labor and its effect on labor induction and labor augmentation [7][8][9][10][11][12][13][14][15]24]. In that meta-analysis, oxytocin discontinuation after the active phase of labor signi cantly lowered the cesarean delivery rate (9.3% vs 14.7%) and uterine tachysystole rate (6.2% vs 13.1%) compared with oxytocin continuation until delivery [24].…”

“…Although there is no consensus regarding the method of administration at the time of induction, it is common practice to adjust the dosage while observing uterine contractions to prevent adverse events. Recent reports have suggested that discontinuation of oxytocin infusion during the active phase of labor signi cantly lowered the risk of uterine tachysystole and cesarean delivery [7][8][9][10][11][12][13][14][15]. Uterine tachysystole is considered to affect fetuses with FGR more adversely than fetuses whose size is appropriate for gestational age (AGA).…”

Physiologic childbirth and active management of the third stage of labor: A latent class model of risk for postpartum hemorrhage

“…37 Minimizing synthetic oxytocin use and considering decreasing or discontinuing use when active effective labor is established may help maximize oxytocin receptor availability such that women's uteri can respond to endogenous or exogenous postpartum oxytocin. [38][39][40] Strategies for prevention or quick repair of genital tract trauma should be a priority; 41 as it may be an overlooked driver of blood loss. 42 Finally, encouraging endogenous oxytocin release by assisting with early breastfeeding deserves further study.…”