Open AccessJudicious use of oxytocin augmentation for the management of prolonged labor
Author(s) -
Rossen Janne,
Østborg Tilde B.,
Lindtjørn Elsa,
Schulz Jørn,
Eggebø Torbjørn M.
Publication year - 2016
Publication title -
acta obstetricia et gynecologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.401
H-Index - 102
eISSN - 1600-0412
pISSN - 0001-6349
DOI - 10.1111/aogs.12821
Subject(s) - medicine , oxytocin , cephalic presentation , cervical dilation , umbilical artery , fetal distress , obstetrics , population , labor induction , fetus , pregnancy , gynecology , anesthesia , gestation , environmental health , biology , genetics
A protocol including judicious use of oxytocin augmentation was investigated to determine whether it would change how oxytocin was used and eventually influence labor and fetal outcomes. Material and methods The population of this cohort study comprised 20 227 delivering women with singleton pregnancies ≥37 weeks, cephalic presentation, spontaneous or induced onset of labor, without previous cesarean section. Women delivering from 2009 to 2013 at Stavanger University Hospital, Norway, were included. Data were collected prospectively. Before implementing the protocol in 2010, oxytocin augmentation was used if progression of labor was perceived as slow. After implementation, oxytocin could only be started when the cervical dilation had crossed the 4‐h action line in the partograph. Results The overall use of oxytocin augmentation was significantly reduced from 34.9% to 23.1% ( p < 0.01). The overall frequency of emergency cesarean sections decreased from 6.9% to 5.3% ( p < 0.05) and the frequency of emergency cesarean sections performed due to fetal distress was reduced from 3.2% to 2.0% ( p = 0.01). The rate of women with duration of labor over 12 h increased from 4.4% to 8.5% ( p < 0.01) and more women experienced severe estimated postpartum hemorrhage (2.6% vs. 3.7%; p = 0.01). The frequency of children with pH <7.1 in the umbilical artery was reduced from 4.7% to 3.2% ( p < 0.01). Conclusions The frequency of emergency cesarean section was reduced after implementing judicious use of oxytocin augmentation. Our findings may be of interest in the ongoing discussion of how the balanced use of oxytocin for labor augmentation can best be achieved.