Oxytocin discontinuation after the active phase of induced labor: A systematic review.

Autor: Hernández-Martínez A; Department of Obstetrics & Gynecology, 'Mancha-Centro' Hospital, Alcázar de San Juan, Ciudad Real, Spain; University of Castilla-La Mancha, Spain. Electronic address: antomatron@gmail.com., Arias-Arias A; Research Support Unit, 'Mancha-Centro' Hospital, Alcazar de San Juan, Ciudad Real, Spain., Morandeira-Rivas A; Department of General and Digestive Surgery, 'Mancha-Centro' Hospital, Alcázar de San Juan, Ciudad Real, Spain., Pascual-Pedreño AI; Department of Obstetrics & Gynecology, 'Mancha-Centro' Hospital, Alcázar de San Juan, Ciudad Real, Spain., Ortiz-Molina EJ; Department of Obstetrics & Gynecology, 'Mancha-Centro' Hospital, Alcázar de San Juan, Ciudad Real, Spain., Rodriguez-Almagro J; University of Castilla-La Mancha, Spain.
Jazyk: angličtina
Zdroj: Women and birth : journal of the Australian College of Midwives [Women Birth] 2019 Apr; Vol. 32 (2), pp. 112-118. Date of Electronic Publication: 2018 Aug 04.
DOI: 10.1016/j.wombi.2018.07.003
Abstrakt: Background: Oxytocin is the most widely used drug in the induction of labor, but it could have potential adverse effects that derive from uterine hyperstimulation.
Aim: To determine the benefits and drawbacks of oxytocin continuation versus oxytocin discontinuation after the active phase of induced labor.
Methods: We systematically searched Pubmed, EMBASE, Scopus, ClinicalTrials.gov and Cochrane Library Plus until October 2017, for randomized controlled trials comparing oxytocin continuation with oxytocin discontinuation when the active phase of labor is reached were included. Data was collected by three reviewers and quality of the included studies assessed using the methodology recommended in the Cochrane Handbook. StatsDirect software was used to calculate risk ratios for binary variables and weighted mean differences for continuous variables. A fixed-effects or random-effects model was used as appropriate.
Results: Nine studies were selected including 1538 women, 774 in the oxytocin continuation group and 764 in the oxytocin discontinuation group. The incidence of cesarean sections (14.3% vs. 8.6%; relative risk, 1.67; 95% confidence interval: 1.25-2.23), uterine hyperstimulation (12.4% vs. 4.7%; relative risk, 2.59; 95% confidence interval: 1.70-3.93) and nonreassuring fetal heart rate (19.2% vs.12.5%; relative risk, 1.55; 95% confidence interval: 1.18-2.02) were significantly higher in the oxytocin continuation group. An increase in the duration of the second stage of labor in the oxytocin discontinuation group was observed (pooled mean difference, -7.03; 95% confidence interval: -9.80 to -4.26).
Conclusions: After the active phase of induced labor, oxytocin continuation increases the risk of cesarean section, uterine hyperstimulation and alterations to the fetal heart rate.
(Copyright © 2018 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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