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High-dose versus low-dose of oxytocin for labour augmentation: a randomised controlled trial.

Journal article
Authors Lotta Selin
Ulla-Britt Wennerholm
Maria Jonsson
Anna Dencker
Gunnar Wallin
Eva Wiberg-Itzel
Elisabeth Almström
Max Petzold
Marie Berg
Published in Women and birth : journal of the Australian College of Midwives
Volume 32
Issue 4
Pages 356-363
ISSN 1878-1799
Publication year 2019
Published at University of Gothenburg Centre for person-centred care (GPCC)
Institute of Health and Care Sciences
Pages 356-363
Language en
Links dx.doi.org/10.1016/j.wombi.2018.09....
www.ncbi.nlm.nih.gov/entrez/query.f...
Subject categories Reproductive and perinatal care

Abstract

Delayed labour progress is common in nulliparous women, often leading to caesarean section despite augmentation of labour with synthetic oxytocin.High- or low-dose oxytocin can be used for augmentation of delayed labour, but evidence for promoting high-dose is weak. Aim To ascertain the effect on caesarean section rate of high-dose versus low-dose oxytocin for augmentation of delayed labour in nulliparous women. Methods Multicentre parallel double-blind randomised controlled trial (ClinicalTrials.gov: NCT01587625) in six labour wards in Sweden. Healthy nulliparous women at term with singleton cephalic fetal presentation, spontaneous labour onset, confirmed delay in labour and ruptured membranes (n=1351) were randomised to labour augmentation with either high-dose (6.6 mU/minute) or low-dose (3.3 mU/minute) oxytocin infusion.1295 women were included in intention-to-treat analysis (high-dose n=647; low-dose n=648). Caesarean section rates did not differ between groups (12.4% and 12.3%, 95% Confidence Interval -3.7 to 3.8). Women with high-dose oxytocin had: shorter labours (-23.4min); more uterine tachysystole (43.2% versus 33.5%); similar rates of instrumental vaginal births, with more due to fetal distress (43.8% versus 22.7%) and fewer due to failure to progress (39.6% versus 58.8%). There were no differences in neonatal outcomes.Our study could not confirm results of two systematic reviews indicating, with weak evidence, that use of high-dose oxytocin was associated with lower frequency of caesarean section.We found no advantages for routine use of high-dose oxytocin in the management of delay in labour. Low-dose oxytocin regimen is recommended to avoid unnecessary events of tachysystole and fetal distress.

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