High dose versus low dose oxytocin for augmentation of delayed labour

Mori, Rintaro; Tokumasu, Hironobu; Pledge, Debbie; Kenyon, Sara

doi:10.1002/14651858.cd007201.pub2

Cited by 47 publications

(23 citation statements)

References 17 publications

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“…Interventions demonstrated to be effective in randomised trials include continuous support for women during childbirth, early amniotomy and early administration of oxytocin in spontaneous labour, and high-dose oxytocin for augmentation of delayed labour. [24][25][26] Level of skill and obstetric training in labour management and operative vaginal deliveries are key issues, and there is some evidence that involvement of consultant obstetricians in decision-making can reduce the likelihood of caesarean. 27 Evidence-based protocols for evaluating fetal status and managing dysfunctional labour need to be developed and promoted.…”

Section: Discussionmentioning

confidence: 99%

Pathways to a rising caesarean section rate: a population-based cohort study

et al. 2012

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ObjectivesTo determine whether the obstetric pathways leading to caesarean section changed from one decade to another. We also aimed to explore how much of the increase in caesarean rate could be attributed to maternal and pregnancy factors including a shift towards delivery in private hospitals.DesignPopulation-based record linkage cohort study.SettingNew South Wales, Australia.ParticipantsFor annual rates, all women giving birth in NSW during 1994 to 2009 were included. To examine changes in obstetric pathways two cohorts were compared: all women with a first-birth during either 1994–1997 (82 988 women) or 2001–2004 (85 859 women) and who had a second (sequential) birth within 5 years of their first-birth.Primary outcome measuresCaesarean section rates, by parity and onset of labour.ResultsFor first-births, prelabour and intrapartum caesarean rates increased from 1994 to 2009, with intrapartum rates rising from 6.5% to 11.7%. This fed into repeat caesarean rates; from 2003, over 18% of all multiparous births were prelabour repeat caesareans. In the 1994–1997 cohort, 17.7% of women had a caesarean delivery for their first-birth. For their second birth, the vaginal birth after caesarean (VBAC) rate was 28%. In the 2001–2004 cohort, 26.1% of women had a caesarean delivery for their first-birth and the VBAC rate was 16%. Among women with a first-birth, maternal and pregnancy factors and increasing deliveries in private hospitals, only explained 24% of the rise in caesarean rates from 1994 to 2009.ConclusionsRising first-birth caesarean rates drove the overall increase. Maternal factors and changes in public/private care could explain only a quarter of the increase. Changes in the perceived risks of vaginal birth versus caesarean delivery may be influencing the pregnancy management decisions of clinicians and/or mothers.

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Section: Discussionmentioning

confidence: 99%

Pathways to a rising caesarean section rate: a population-based cohort study

et al. 2012

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“…Two recent systematic reviews have suggested that a higher-dose regimen of oxytocin may reduce the risk of caesarean section and increase spontaneous vaginal birth for women who require augmentation for delay in labour. 3,4 Although both reviews reported increased hyperstimulation in the high-dose groups, neither maternal nor neonatal morbidity were increased. The authors of both reviews highlight the uncertainty around the evidence, the paucity and quality of the existing studies, and insufficient data on neonatal outcomes and maternal birth experience, making this a key priority for further research, as identified by the NICE Intrapartum Care Guideline, 2 and by the RCOG Intrapartum Clinical Study Group (http:// www.bmfms.org.uk/Intrapartum-care-CSG/c-1-38.htm).…”

Section: Introductionmentioning

confidence: 90%

“…Two recent systematic reviews have suggested that a higher‐dose regimen of oxytocin may reduce the risk of caesarean section and increase spontaneous vaginal birth for women who require augmentation for delay in labour . Although both reviews reported increased hyperstimulation in the high‐dose groups, neither maternal nor neonatal morbidity were increased.…”

Section: Introductionmentioning

confidence: 99%

Standard‐ or high‐dose oxytocin for nulliparous women with confirmed delay in labour: quantitative and qualitative results from a pilot randomised controlled trial

Kenyon

Armstrong

Johnston

et al. 2013

BJOG

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Objective Evidence suggests that a high dose of oxytocin for nulliparous women at 37-42 weeks of gestation with confirmed delay in labour increases spontaneous vaginal birth. We undertook a pilot study to test the feasibility of this treatment.Design Pilot double-blind randomised controlled trial.Setting Three teaching hospitals in the UK.Population A total of 94 consenting nulliparous women at term with confirmed delay in labour were recruited, and 18 were interviewed.Methods Women were assigned to either a standard (2 mU/min, increasing every 30 minutes to 32 mU/minute) or a high-dose regimen (4 mU/minute, increasing every 30 minutes to 64 mU/ minutes) oxytocin by computer-generated randomisation. Simple descriptive statistics were used, as the sample size was insufficient to evaluate clinical outcomes. The constant comparative method was used to analyse the interviews.Main outcomes measures The main outcome measures: number of women eligible; maternal and neonatal birth; safety; maternal psychological outcomes and experiences; health-related quality of life outcomes using validated tools and data on health service resource use; incidence of suspected delay of labour (cervical dilatation of <2 cm after 4 hours, once labour is established); and incidence of confirmed delay of labour (progress of <1 cm on repeat vaginal examination after a period of 2 hours).Results We successfully developed systems to recruit eligible women in labour and to collect data. Rates of spontaneous vaginal birth (10/47 versus 12/47, RR 1.2, 95% CI 0.6-2.5) and caesarean section (15/47 versus 17/47, RR 1.1, 95% CI 0.6-2.0) were increased, and rates of instrumental birth were reduced (21/ 47 versus 17/47, RR 0.8, 95% CI 0.5-1.3). No evidence of increased harm for either mother or baby was found. The incidences of suspected delay (14%) and confirmed delay (11%) in labour were less than anticipated. Of those who did not go on to have delayed labour confirmed, all except one woman gave birth vaginally.Conclusions A pilot trial assessing the efficacy of high-dose oxytocin was feasible, but uncertainty remains, highlighting the need for a large definitive trial. The implementation of national guidance of suspected and confirmed delay in labour is likely to reduce intervention.Keywords Pilot RCT, nulliparous, delayed labour, oxytocin.Please cite this paper as: Kenyon S, Armstrong N, Johnston T, Walkinshaw S, Petrou S, Howman A, Cheed V, Markham C, McNicol S, Willars J, Waugh J. Standard-or high-dose oxytocin for nulliparous women with confirmed delay in labour: quantitative and qualitative results from a pilot randomised controlled trial.

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“…Exogenous oxytocin administration to pregnant woman strongly induces contractions (Mori et al, 2011) but plasma oxytocin does not cross placenta toward the fetus (Chard et al, 1971; Patient et al, 1999). However, by use of an in vitro system with dually perfused isolated cotyledons from term human placenta, bi-directional diffusion of oxytocin has been demonstrated across the maternal-fetal barrier (Malek et al, 1996).…”

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confidence: 99%