Effect of oxytocin discontinuation during the active phase of labor

Öztürk, Filiz Halıcı; Yılmaz, Saynur; Yalvaç, Serdar; Kandemir, Ömer

doi:10.3109/14767058.2014.906573

Cited by 12 publications

(11 citation statements)

References 12 publications

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“…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%

“…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. 10,13,15 Girard et al 13 found that the active phase was around 2 hours longer when oxytocin was discontinued, whereas Ozturk et al 15 found only 30 minutes' prolongation. It could be argued that a shorter duration is not necessarily always beneficial.…”

Section: Discussionmentioning

confidence: 99%

“…Most of these studies included full-term singleton pregnancies but excluded women with a history of prior caesarean section. 10,12,14,15 However, we did not exclude women with previous caesarean section or those who had a preterm delivery. In our study, 13% of the labouring women had one prior caesarean section, which reflects the normal proportion of births by caesarean section in Denmark, around 20%.…”

Section: Discussionmentioning

confidence: 99%

“…Our study setting reflects a daily obstetrical practice at a busy delivery unit, not an experimental setting with different exclusion criteria during the study process, as has been described in previous studies. 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.…”

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%

See 4 more Smart Citations

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: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Strengths and Limitationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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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Discontinuation of intravenous oxytocin in the active phase of induced labour

Boie

Glavind

Velu

et al. 2018

Cochrane Database of Systematic Reviews

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Discontinuing IV oxytocin stimulation after the active phase of labour has been established may reduce caesarean delivery but the evidence for this was low certainty. When restricting our analysis to those trials that separately reported participants who reached the active phase of labour, our results showed there is probably little or no difference between groups. Discontinuing IV oxytocin may reduce uterine tachysystole combined with abnormal FHR.Most of the trials had 'Risk of bias' concerns which means that these results should be interpreted with caution. Our GRADE assessments ranged from very low certainty to moderate certainty. Downgrading decisions were based on study limitations, imprecision and indirectness.Future research could account for all women randomised and, in particular, note those who delivered before the point at which they would be eligible for the intervention (i.e. those who had caesareans in the latent phase), or because labour was so rapid that the infusion could not be stopped in time.Future trials could adopt the outcomes listed in this review including maternal and neonatal mortality, maternal satisfaction, and breastfeeding.

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Oxytocin administration during spontaneous labor: Guidelines for clinical practice. Chapter 4: Oxytocin efficiency according to implementation in insufficient spontaneous labor

Coulm

Tessier²

2017

Journal of Gynecology Obstetrics and Human Reproduction

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Effect of oxytocin discontinuation during the active phase of labor

Abstract: It is not reasonable to discontinue oxytocin infusion at the beginning of active labor. Nevertheless, for an accurate conclusion expanded investigations are needed.

Cited by 12 publications

References 12 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

Discontinuation of intravenous oxytocin in the active phase of induced labour

Oxytocin administration during spontaneous labor: Guidelines for clinical practice. Chapter 4: Oxytocin efficiency according to implementation in insufficient spontaneous labor

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