Research
Obstetrics
Oxytocin discontinuation during active labor in women who undergo labor induction

Presented at the 32nd annual meeting of the Society for Maternal-Fetal Medicine, Dallas, TX, Feb. 6-11, 2012.
https://doi.org/10.1016/j.ajog.2012.08.035Get rights and content

Objective

The purpose of this study was to determine whether there is an increase in the cesarean delivery rate in women who undergo induction when oxytocin is discontinued in the active phase of labor.

Study Design

We conducted a prospective randomized controlled trial of women who underwent induction of labor at term; they were assigned randomly to either routine oxytocin use (routine) or oxytocin discontinuation (DC) once in active labor. Analysis was by intention to treat.

Results

Two hundred fifty-two patients were eligible for study analysis: 127 patients were assigned randomly to the routine group and 125 patients were assigned randomly to the DC group. Cesarean delivery rate was similar between the groups (routine, 25.2% [n = 32] vs the DC group, 19.2% [n = 24]; P = .25). There was a higher chorioamnionitis rate and slightly longer active phase in those women who were assigned to the DC group. In adjusted analysis, the rate of chorioamnionitis was not different by randomization group but was explained by the duration of membrane rupture and intrauterine pressure catheter placement.

Conclusion

Discontinuation of oxytocin in active labor after labor induction does not increase the cesarean delivery rate significantly.

Section snippets

Materials and Methods

This was a prospective randomized controlled trial of women who underwent induction of labor from February 2009 to August 2011 at Lehigh Valley Health Network. The primary outcome was the rate of cesarean delivery among women for whom oxytocin was either discontinued or continued once in active labor. Institutional review board approval was obtained, and written informed consent was obtained from participants. The trial was registered at ClinicalTrials.gov, ID NCT00957593.

Our inclusion

Results

Three hundred three patients agreed to enroll in the study (Figure); 38 women did not complete the enrollment process, and 13 pregnancies were screen failures, allowing 252 patients for enrollment and participation in the study. Enrollment was stopped after 30 months primarily because of enrollment challenges. One hundred twenty-seven women (50.4%) were randomly assigned to the routine group, and 125 women (49.6%) were randomly assigned to the DC group once active labor was achieved.

Comment

Our data suggest that, once labor is active in women being induced, oxytocin may be discontinued if regular contractions continue to generate cervical change, without increasing the cesarean delivery rate. Restarting oxytocin for arrest of dilation and/or decrease in contractions does not appear to be associated with an increased risk of cesarean delivery for arrest disorders. However, oxytocin discontinuation can lead to labor prolongation and a higher rate of chorioamnionitis; the latter is

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    The response of human uterus to oxytocin throughout pregnancy

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    The authors report no conflict of interest.

    Reprints not available from the authors.

    Cite this article as: Diven LC, Rochon ML, Gogle J, et al. Oxytocin discontinuation during active labor in women who undergo labor induction. Am J Obstet Gynecol 2012;207:471.e1-8.

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