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

Autor: Selin L; University of Gothenburg, Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg, Sweden; NU-Hospital Group, Department of Obstetrics and Gynecology, Trollhättan, Sweden. Electronic address: lotta.selin@vgregion.se., Wennerholm UB; University of Gothenburg, Department of Obstetrics and Gynecology, Institute for Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden., Jonsson M; Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden., Dencker A; University of Gothenburg, Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg, Sweden; University of Gothenburg, Centre for Person-centred Care, Sahlgrenska Academy, Gothenburg, Sweden., Wallin G; University of Gothenburg, Department of Obstetrics and Gynecology, Institute for Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden., Wiberg-Itzel E; Karolinska Institute, Soder Hospital, Department of Clinical Science and Education, Section of Obstetrics and Gynaecology, Stockholm, Sweden., Almström E; NU-Hospital Group, Department of Obstetrics and Gynecology, Trollhättan, Sweden., Petzold M; University of Gothenburg, Health Metrics Unit, The Sahlgrenska Academy, Gothenmurg, Sweden., Berg M; University of Gothenburg, Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg, Sweden; Sahlgrenska University Hospital, Obstetric Unit, Gothenburg, Sweden.
Jazyk: angličtina
Zdroj: Women and birth : journal of the Australian College of Midwives [Women Birth] 2019 Aug; Vol. 32 (4), pp. 356-363. Date of Electronic Publication: 2018 Oct 16.
DOI: 10.1016/j.wombi.2018.09.002
Abstrakt: Problem: Delayed labour progress is common in nulliparous women, often leading to caesarean section despite augmentation of labour with synthetic oxytocin.
Background: 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.
Findings: 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.
Discussion: 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.
Conclusion: 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.
(Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.)
Databáze: MEDLINE
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