Does Stopping Oxytocin in Active Phase of Labor Alter Cesarean Section Rates?
Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Discuss the method used in this study to determine risks and benefits of continuing oxytocin infusion once active labor has begun 2. State the authors conclusions and recommendations regarding continuing or discontinuing oxytocin infusion in the active stage of labor
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Method of Participation and Request for Credit
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 31 2017 through Dec 31 2021, participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.
Designated for 0.1 contact hours of pharmacotherapy credit for Advance Practice Registered Nurses.
There is no clinical agreement on when to discontinue oxytocin infusion in labor
Saccone et al. (Obstetrics and Gynecology, 2017) evaluated the effects of stopping oxytocin once the active phase of labor has begun
Systematic review and meta-analysis
Performed a literary search of all randomized control trials (RCTs) comparing discontinuation (ie, intervention group) and continuation (ie, control group) of oxytocin infusion after active phase of labor
Discontinuation: Defined as discontinuing oxytocin infusion when the active phase of labor was achieved
Continuation: Defined as continuing oxytocin infusion until delivery
Active Phase: Definition differed but generally ≥ 5cm
If arrest occurred (no cervical dilation in 2 hours or inadequate uterine contractions for ≥ 2 hours), oxytocin restarted
Only singleton gestations with vertex presentation at term were included
The primary outcome was the incidence of cesarean section delivery
Data was pooled from nine RCTs, totaling 1538 singleton gestations
All trials only addressed women undergoing labor induction
Compared to the continuous group, the discontinuation group had a significantly lower risk of
Cesarean delivery (9.3% compared with 14.7%; relative risk [RR] 0.64, 95% CI 0.48–0.87)
Uterine tachysystole (6.2% compared with 13.1%; RR 0.53, 95% CI 0.33–0.84)
Discontinuation of oxytocin infusion was associated with an increase in the duration of the active phase of labor (mean difference 27.65 minutes, 95% CI 3.94–51.36)
In singleton gestations with cephalic presentation at term undergoing induction, discontinuation of oxytocin infusion after active phase of labor reduced risk for cesearean section and tachysystole
The authors state
Given this evidence, discontinuation of oxytocin infusion once the active stage of labor is established in women being induced should be considered as an alternative and efficacious management plan
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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