Discontinuing Oxytocin in Active Labor Reduces Cesarean Risk

TOPLINE:

Discontinuing oxytocin during active labor was associated with a 20% lower risk for cesarean delivery and reduced the risk for uterine tachysystole and non-reassuring fetal heart rate tracings. The approach extends labor duration by approximately 30 minutes but shows potential benefits for delivery outcomes.

METHODOLOGY:

• Researchers conducted a systematic review and meta-analysis of 15 randomized controlled trials involving 5734 patients who received oxytocin for induction or augmentation of labor.
• Analysis included trials comparing discontinuation with continuation of oxytocin in active labor, with cesarean delivery as the primary outcome.
• Secondary outcomes encompassed postpartum hemorrhage, blood loss, infectious outcomes, Apgar scores, umbilical arterial pH, neonatal therapeutic hypothermia, neonatal intensive care unit admission, neonatal resuscitation, and death.
• Risk of bias assessment utilized guidelines from the Cochrane Handbook for Systematic Reviews of Interventions, with meta-analysis performed using Review Manager 5.4.1 and StataSE 16.

TAKEAWAY:

• Discontinuation of oxytocin in active labor was associated with a lower risk for cesarean delivery (relative risk [RR], 0.80; 95% CI, 0.66-0.97; 95% prediction interval, 0.38-1.22).
• Patients who discontinued oxytocin showed a reduced risk for uterine tachysystole (RR, 0.45; 95% CI, 0.34-0.60; I², 26%) and non-reassuring fetal heart rate tracing (RR, 0.64; 95% CI, 0.49-0.82; I², 41%).
• Duration of active labor increased by a mean difference of 30.38 min (95% CI, 14.77-46.00) and second stage of labor by a mean difference of 6.32 min (95% CI, 3.87-8.76) with oxytocin discontinuation.
• According to the authors, while the pooled analysis suggests beneficial effects, findings were dependent on inclusion of studies with concerns regarding trustworthiness.

IN PRACTICE:

“The frequency of chorioamnionitis was not reported as an outcome for the majority of the trials, a significant potential concern with protracted labor; however, labor was only prolonged by approximately 30 minutes. The duration of oxytocin discontinuation in active labor was not reported in any of the included trials; however, we included total oxytocin dosage and total oxytocin duration when available,” wrote the authors of the study.

SOURCE:

This study was led by Julia Whitley, MD, Washington University in St. Louis, St. Louis. It was published online in American Journal of Obstetrics and Gynecology.

LIMITATIONS:

The researchers noted significant heterogeneity in study designs among individual trials, including variations in patient demographics, definitions of active phase, and oxytocin restart criteria. Six trials excluded patients with chronic medical conditions, and the mean maternal body mass index was < 30, limiting generalizability to the United States induction of labor populations. The frequency of chorioamnionitis was not reported as an outcome in most trials, despite being a significant concern with protracted labor.

DISCLOSURES:

The authors reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.