Oxytocin administration for induction and augmentation of labour in polish maternity units – an observational study

Abstract

Background There is not enough data regarding practices and protocols on the dose of oxytocin administrated to women during labour. Empirical evidence indicates that compliance with the guidelines improves the quality of healthcare and reduces adverse effects. The study aimed to evaluate practices of oxytocin provision for labour induction and augmentation in two maternity units in Poland. Methods The article presents a prospective observational study. Data from 545 (n = 545) labours was collected in two maternity units. First, the total dose (the total amount of oxytocin provided from the beginning in the labour ward until delivery including the III and IV stage of labour) and cumulative dose of oxytocin (the amount of oxytocin given until the birth of the neonate) administered to women during labour was calculated. Then, the relationship between the cumulative dose of oxytocin and short term perinatal outcomes (mode of delivery, use of epidural anaesthesia, Apgar scores, birth weight and postpartum blood loss) was analysed. Finally, the compliance of oxytocin supply during labour with national guidelines in the following five criteria: medium, start dose, escalation rate, interval, the continuation of infusion after established labour was examined. Results The average cumulative dose of oxytocin administrated to women before birth was 4402 mU following labour induction and 2366 mU following labour augmentation. The actual administration of oxytocin deviated both from the unit and national guidelines in 93.6% of all observed labours (mainly because of continuation of infusion after established labour). We found no statistically significant correlation between the cumulative dose of oxytocin administered and mode of delivery, immediate postpartum blood loss or Apgar scores. There was no observed effect of cumulative dose oxytocin on short-term perinatal outcomes. The two units participating in the study had similar protocols and did not differ significantly in terms of total oxytocin dose, rates of induction and augmentation - the only observed difference was the mode of delivery. Conclusions The study showed no effect of the mean cumulative oxytocin dose on short-term perinatal outcomes and high rate of non-compliance of the practice of oxytocin administration for labour induction and augmentation with the national recommendations. Cooperation between different professional groups of maternity care providers should be considered in building national guidelines for maternity care.. Further studies investigating possible long-term effects of the meant cumulative dose of oxytocin and the reasons for non-compliance of practice with guidelines should be carried out.

Use and Effects of Augmentation of Labor with Oxytocin: A Single-Center, Retrospective, Case-Control Study of 4350 Women in Warsaw, Poland, 2015-2020

“…French researchers Girault et al showed that the determinants of abuse of augmentation of labor were, among others, epidural anesthesia [ 21 ]. Baranowska et al observed a correlation between the average cumulative dose of oxytocin administered during labor and the use of epidural anesthesia [ 22 ]. Other researchers came to similar conclusions, both in terms of more frequent use of oxytocin after the start of epidural anesthesia [ 23 , 24 ] and more frequent use of epidural anesthesia after the augmentation of labor with oxytocin [ 25 , 26 ].…”

“…Other researchers came to similar conclusions, both in terms of more frequent use of oxytocin after the start of epidural anesthesia [ 23 , 24 ] and more frequent use of epidural anesthesia after the augmentation of labor with oxytocin [ 25 , 26 ]. To some extent, this can be explained by more painful contractions that are stimulated by oxytocin and movement limitations caused by the required continuous CTG recording during the stimulation of uterine contractions [ 22 ].…”

“…Research by Litorp et al (2020) also showed that women who had stimulated labor were more often younger [ 7 ]. However, in a study conducted by Baranowska et al (2021), there was no statistically significant correlation between the administered dose of oxytocin and the age of the mother [ 22 ].…”

Induction of Labour

“…It is secreted when triggered by labour, lactation, social interaction, and stressors. Oxytocin acts on the myometrium to induce uterine contractions via G-proteins with the subsequent release of intracellular calcium stores through a complex interplay on its activity on phospholipase C. Its potency is directly proportional with advancing gestational age when there are sufficient oxytocin receptors [43]. The synthetic oxytocin is a cyclic nonapeptide which is identical to the natural oxytocin obtained via chemical synthesis.…”

Spontaneous Perineal Trauma during Non-Operative Childbirth—Retrospective Analysis of Perineal Laceration Risk Factors

“…Oxytocin is one of the most used drugs in delivery rooms, used to induce or stimulate childbirth, which is the subject of interest to researchers around the world [37][38][39]. Nakai et al (2006) conducted studies to learn about the incidence and risk factors of severe perineal trauma in Japanese patients.…”