Outcome of early versus delayed oxytocin augmentation in nulliparous women on the duration of labour and other, obstetric and neonatal outcome - a randomized controlled ftrial

ABSTRACT

To determine the outcome of early versus delayed Oxytocin augmentation in nulliparous women on the duration of labor and other obstetric and neonatal outcomes. Aprospective randomized trial. The study was conducted at Pakistan Railways Hospital, for the duration of 1 year with effect from January 2010 January, 2011. It is 400 bedded teaching hospital affiliated with IIMC-Tof Riphah International University, Islamabad. In healthy nulliparous women with normal pregnancy.the progress of labor was thoroughly monitored and documented every 23 hours. If there was still no progress 1 hour after amniotomy, the woman was randomly allocated to either labor augmentation by oxytocin infusion or to postponement of oxytocin augmentation for 3 hours [expectant group, n = 158]. Women whose labors had progressed satisfactory [1 cm/hour] after amniotomy were not randomized. Participants were managed according to a standard protocol entailing continuous documentation of the progress of labour, the amount of oxytocin administered, and obstetrical and neonatal outcomes. Oxytocin infusion was started at 6 mil/minute and was raised by 6 mU/minute every 30 minutes until efficient contractions were established in the early oxytocin group. In the expectant group, if no progress occurred after 3 hours, the women were reassessed regarding the need for oxytocin augmentation. Data were analyzed with SPSS 15.0. The MannWhitney U test was used to compare means. Proportions of events were compared with Fisher's exact test or chi-square analysis. Statistical significance was set at a P value of <0.05. The caesarean section rate was 9% in the early oxytocin group and 10.7% in the expectant group [OR 0.8, 95% Cl 0.51.4], and instrumental vaginal delivery 17% in the early oxytocin versus 12% in the expectant group [OR 1.5, 95% Cl 0.972.4]. Early initiation of oxytocin resulted in a mean decrease of 85 minutes in the randomization to delivery interval. Early administration of oxytocin did not change the rate of caesarean section or instrumental vaginal delivery but shortened labor duration significantly in women with a 2-hour arrest in cervical dilatation. No other clear benefits or harms were seen between early and delayed administration of oxytocin