Effect of Oxytocin Discontinuation during the Active Phase of Labor on the Duration of Labor and the Maternal & Fetal Outcomes in Primi-gravida

Abstract

Oxytocin is one of the most important medications used in obstetric practice for the induction and augmentation of labor. Despite the intensive use of oxytocin, relatively few studies have focused on the duration of oxytocin administration in labor (Diven et al., 2012). Oxytocin is also frequently implicated in professional liability claims and thus poses a dual concern for individual clinicians and the organizations in which they practice. Approximately half of all paid obstetric litigation claims involve allegations of oxytocin misuse ( Clark et al,. 2006) Recently, oxytocin was added to the list of high-alert medications designated by the Institute for Safe Medication Practices (ISMP), a distinction reserved to only 11 other specific drugs. Such drugs are defined as those “bearing a heightened risk of harm when they are used in error” and that may “require special safeguards to reduce the risk of error.”(ISMP 2008). The duration of oxytocin infusion during induction of labor and out come of different proposed protocols is investigated by Etty Daniel Speigel and published in 2004 and concluded that "There is no advantage in continuing oxytocin infusion after the onset of active labor."﴾Etty Daniel-Spiegel et al., 2004﴿

Ustunyurt et al. in 2007 investigated the effects of discontinuing oxytocin infusion on labor outcomes once the active stage of labor was established and concluded that "Discontinuing oxytocin infusion once the active stage of labor is established may be an alternative protocol in developing countries where the conditions for fetal monitoring and emergency cesarean section are less available".

Our study is a Randomized controlled trial that was conducted at Ain Shams Maternity hospital, Cairo, Egypt from October 2015 and March 2016 to evaluate the effect of discontinuation of oxytocin in the active phase of labor versus continuation of oxytocin until delivery at term primigravidae. We recruited 172 women for the study after exclusion of women with any of exclusion criteria, 86 women in the discontinuation group (study group) and 86 in the continuation group (control group). Initially, both groups received oxytocin infusion administered according to the Danish Society of Obstetrics and Gynaecology (DSOG) guidelines (Guidelines of oxytocin). The oxytocin was discontinued in the study group when cervical dilatation reached 5cm and continued in the control group till delivery of the fetus and the placenta. There was no significant statistical difference between the two groups (group I and group II) in the demographic characteristics. This allowed us to compare the two groups confidently as it alleviated the effect of many confounding factors and added much to the homogeneity of the study groups. The rate of Vaginal delivery was significantly more frequent among study (discontinued) group than among control (continued )group but there was no significant difference between both groups regarding Indications of cesarean section (arrest of labor, non reassuring fetal heart rate, and chorioamnionitis causing fetal distress) .