Oxytocin Overuse During Induction: Is Managing with Less Appropriate?
Oxytocin discontinuation during active labor did not raise risk for cesarean delivery, but did lead to longer labor and higher rates of chorioamnionitis.
Although oxytocin is the most widely used agent for inducing labor, optimal regimens for this indication remain unknown. Researchers conducted a trial in 252 pregnant women ...who underwent induction to determine if discontinuing oxytocin during labor affected likelihood of cesarean delivery. Participants were randomized to routine induction (oxytocin administration until delivery) or oxytocin discontinuation at attainment of active labor (defined as regular uterine contractions and cervical dilation
cm).
In fully 25% of patients in the discontinuation group, oxytocin infusion was maintained after active labor was achieved (reasons not always known); moreover, in another 46% of patients in this group, oxytocin had to be restarted after discontinuation (as allowed per study protocol). Therefore, the data were also analyzed by actual treatment received. In that analysis, cesarean birth rates were similar in the discontinuation and routine groups (21% and 23%, respectively). Median duration of active labor was longer in the discontinuation group (4.2 vs. 3.0 hours; P=0.004), and chorioamnionitis was diagnosed more often (15% vs. 6%; P=0.01).
Comment: Despite its limitations (e.g., lack of blinding, continuation or restarting of oxytocin in the discontinuation group), this study is conceptually interesting. Oxytocin is a high-alert medication, and investigating ways to curtail its use is worthwhile. Once active labor is established, oxytocin discontinuation does not seem to alter risk for cesarean delivery; however, it does lead to longer labor and higher rates of chorioamnionitis. Thus, clinicians should carefully assess labor progression in women who might be at risk for chorioamnionitis — and larger, more-rigorous studies are necessary before oxytocin discontinuation during active labor can be approved.
Oxytocin discontinuation during active labor did not raise risk for cesarean delivery, but did lead to longer labor and higher rates of chorioamnionitis.
Although oxytocin is the most widely used agent for inducing labor, optimal regimens for this indication remain unknown. Researchers conducted a trial in 252 pregnant women ...who underwent induction to determine if discontinuing oxytocin during labor affected likelihood of cesarean delivery. Participants were randomized to routine induction (oxytocin administration until delivery) or oxytocin discontinuation at attainment of active labor (defined as regular uterine contractions and cervical dilation
cm).
In fully 25% of patients in the discontinuation group, oxytocin infusion was maintained after active labor was achieved (reasons not always known); moreover, in another 46% of patients in this group, oxytocin had to be restarted after discontinuation (as allowed per study protocol). Therefore, the data were also analyzed by actual treatment received. In that analysis, cesarean birth rates were similar in the discontinuation and routine groups (21% and 23%, respectively). Median duration of active labor was longer in the discontinuation group (4.2 vs. 3.0 hours; P=0.004), and chorioamnionitis was diagnosed more often (15% vs. 6%; P=0.01).
Comment: Despite its limitations (e.g., lack of blinding, continuation or restarting of oxytocin in the discontinuation group), this study is conceptually interesting. Oxytocin is a high-alert medication, and investigating ways to curtail its use is worthwhile. Once active labor is established, oxytocin discontinuation does not seem to alter risk for cesarean delivery; however, it does lead to longer labor and higher rates of chorioamnionitis. Thus, clinicians should carefully assess labor progression in women who might be at risk for chorioamnionitis — and larger, more-rigorous studies are necessary before oxytocin discontinuation during active labor can be approved.
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