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Grand Rounds

RCT Results: Standard vs High Dose of Oxytocin for Labor Augmentation

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BACKGROUND AND PURPOSE:

  •  Son et al. (Obstetrics & Gynecology, 2021) compared high-dose to standard dosing for labor augmentation

METHODS:

  • Double-blind randomized clinical trial
  • Participants
    • Nulliparous, admitted with spontaneous onset of labor
    • ≥36 weeks
    • Undergoing augmentation of labor
  • Interventions
    • High-dose oxytocin regime
      • Initial and incremental rates of 6 milliunits/min
    • Standard-dose regime
      • Initial and incremental rates of 2 milliunits/min
  • Protocol
    • No maximum rate limit due to lack of evidence for specific safety threshold
    • Infusion was titrated based on frequency of contractions and avoidance of abnormal fetal heart rate patterns
  • Sample size
    • Target difference: 6.6% absolute reduction in rate of the primary outcome
    • 80% power | Two-sided type I error rate of 5%
    • Sample size: 501 per group
  • Primary outcome
    • Cesarean birth
  • Secondary outcomes
    • Labor duration | Clinical chorioamnionitis | Endometritis | PPH | 5 min Apgar ≤3 | Umbilical artery acidemia | NICU admission | Perinatal death | Severe perinatal morbidity composite

RESULTS:

  • High dose: 502 women | standard dose: 501 women
    • Population: Majority were white, married or living as married, and had commercial insurance
    • Baseline characteristics between groups were similar
  • No difference in incidence of cesarean birth between the two groups
    • High dose: 14.5%
    • Standard dose: 14.4%
    • Relative risk (RR) 1.01 (95% CI, 0.75 to 1.37)
  • The high-dose group had a significantly
    • Shorter mean labor duration (P < 0.001)
      • High dose: 9.1 hours
      • Standard dose: 10.5 hours
    • Lower chorioamnionitis incidence
      • High dose: 10.4%
      • Standard dose: 15.6%
      • RR 0.67 (95% CI, 0.48 to 0.92)
  • Umbilical artery acidemia was significantly less frequent in the high-dose group in complete case analysis, but when missing data was accounted for (through multiple imputation) there was no significant difference
    • RR 0.55 (95% CI, 0.29 to 1.04)
  • No significant differences were identified for other secondary outcomes

CONCLUSION:

  • Augmenting labor with high-dose vs standard-dose oxytocin in nulliparous women did not reduce cesarean rates, but did lead to shorter duration of labor and a lower incidence of chorioamnionitis
  • The authors state

Shorter time to delivery and the evidence suggesting decreased maternal and perinatal complications in the high-dose group, support the view that a high-dose regimen may be preferred in this population

Learn More – Primary Sources:

High-Dose Compared With Standard-Dose Oxytocin Regimens to Augment Labor in Nulliparous Women

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Related ObG Topics:

Does Stopping Oxytocin in Active Phase of Labor Alter Cesarean Section Rates?
CONDISOX RCT Results: Does Discontinuing Oxytocin in Active Labor Decrease Cesarean Deliveries?
RCT Results: Does the Addition of Uterotonics to Prophylactic Oxytocin Reduce PPH following Cesarean for Arrest of Labor

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