Oxytocin Versus No Treatment or Delayed Treatment for Slow Progress in the First Stage of Spontaneous Labour
Obstetrics and Gynecology, 11/04/2011
For women making slow progress in spontaneous labour, treatment with oxytocin as compared with no treatment or delayed oxytocin treatment did not result in any discernable difference in the number of caesarean sections performed. In addition there were no detectable adverse effects for mother or baby. The use of oxytocin was associated with a reduction in the time to delivery of approximately two hours which might be important to some women. However, if the primary goal of this treatment is to reduce caesarean section rates, then doctors and midwives may have to look for alternative options. Methods
- The Cochrane Pregnancy and Child birth Group's Trials Register (30 April 2011) and bibliographies of relevant papers were searched.
- Randomized controlled trials which compared oxytocin with either placebo, no treatment or delayed oxytocin in the active stage of spontaneous labour in low-risk women at term were selected.
- Two authors independently assessed studies for inclusion, assessed risk of bias and extracted data.
- Additional information from trial authors were sought.
- Eight studies in the review involving a total of 1338 low-risk women in the first stage of spontaneous labour at term were included.
- Two comparisons were made; 1) the use of oxytocin versus placebo or no treatment (three trials); 2) the early use of oxytocin versus its delayed use (five trials).
- There were no significant differences in the rates of caesarean section or instrumental vaginal delivery in either comparison.
- Early use of oxytocin resulted in no significant differences in a range of neonatal and maternal outcomes.
- Use of early oxytocin resulted in a statistically significant reduction in the mean duration in labour of approximately two hours but did not increase the normal delivery rate.
- There was significant heterogeneity for this analysis and a random-effects meta-analysis was carried out; however, all of the trials are strongly in the same direction so it is reasonable to conclude that this is the true effect.
- A random-effects meta-analysis for the four other analyses which showed substantial heterogeneity in the review were also performed.