Oxytocin versus no treatment or delayed treatment for slow progress in the first stage of spontaneous labour

In women making slow progress in spontaneous labour, oxytocin appears to reduce the time to delivery of approximately two hours without increasing caesarean sections compared with no treatment or delayed oxytocin treatment.

Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment and incomplete outcome data in half of the studies).

Summary

A Cochrane review included 8 studies with a total of 1338 low-risk women in the first stage of spontaneous labour at term. Two comparisons were made; 1) the use of oxytocin versus placebo or no treatment (3 trials); 2) the early use of oxytocin versus its delayed use (5 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 an increase in uterine hyperstimulation associated with fetal heart changes. However, the early use of oxytocin versus its delayed use 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 we carried out a random-effects meta-analysis; however, all of the trials are strongly in the same direction.

Clinical comments

Date of latest search: 17 June 2013

Ədəbiyyat

1. Bugg GJ, Siddiqui F, Thornton JG. Oxytocin versus no treatment or delayed treatment for slow progress in the first stage of spontaneous labour. Cochrane Database Syst Rev 2013;(6):CD007123.