Cochrane Database Syst Rev. 2011 Jul 6;(7):CD007123.
Oxytocin versus no treatment or delayed treatment for slow progress in the first stage of spontaneous labor.
Bugg GJ, Siddiqui F, Thornton JG.
Department of Obstetrics and Gynaecology, Nottingham University Hospitals NHS Trust, Queen's Medical Centre Campus, Derby Road, Nottingham, UK, NG12 4AA.
Slow progress in the first stage of spontaneous labor is associated with an increased cesarean section rate and fetal and maternal morbidity.
Oxytocin has long been advocated as a treatment for slow progress in labor but it is unclear to what extent it improves the outcomes for that labor and whether it actually reduces the cesarean section rate or maternal and fetal morbidity.
This review will address the use of oxytocin and whether it improves the outcomes for women who are progressing slowly in labor compared to situations where it is not used or where its administration is delayed.
To determine if the use of oxytocin for the treatment of slow progress in the first stage of spontaneous labor is associated with a reduction in the incidence of cesarean sections, or maternal and fetal morbidity compared to situations where it is not used or where its administration is delayed.
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 April 2011) and bibliographies of relevant papers.
Randomized controlled trials which compared oxytocin with either placebo, no treatment or delayed oxytocin in the active stage of spontaneous labor in low-risk women at term.
DATA COLLECTION AND ANALYSIS:
Two authors independently assessed studies for inclusion, assessed risk of bias and extracted data. We sought additional information from trial authors.
We included eight studies in the review involving a total of 1338 low-risk women in the first stage of spontaneous labor at term. 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 cesarean 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 labor 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 so it is reasonable to conclude that this is the true effect. We also performed a random-effects meta-analysis for the four other analyses which showed substantial heterogeneity in the review.
For women making slow progress in spontaneous labor, treatment with oxytocin as compared with no treatment or delayed oxytocin treatment did not result in any discernable difference in the number of cesarean 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 cesarean section rates, then doctors and midwives may have to look for alternative options.