To compare duration of labor, mode of delivery, maternal satisfaction and early neonatal outcomes following immediate (within 15-30 minutes) versus delayed (2 hours) oxytocin administration after amniotomy among low risk women in labour.
Pragmatic randomized single blind two armed clinical trial in which women in labour at term who had hypotonic uterine contractions were assigned to immediate (within 15-30 minutes) versus delayed (at 2 hours) oxytocin administration after amniotomy at Kenyatta National Hospital in Nairobi, Kenya. We compared the duration of time from amniotomy to second stage, vaginal delivery and decision to cesarean delivery between the two arms. Secondary outcomes were mode of delivery, early neonatal outcomes, maternal satisfaction and actual need of oxytocin. We used intent-to treat analysis for all outcomes.
A total of 209 low risk women at a cervical dilation of 4-5 cm and with hypotonic uterine contractions were enrolled between February and July 2018 and randomized to immediate and delayed oxytocin administration after amniotomy. Labor was monitored using a partograph. The baseline characteristics were similar between the two groups. The average time to delivery was 4.6 (standard deviation [SD] 2.6) hours versus 4.9 hours (SD 2.7) following immediate versus delayed oxytocin administration respectively and was similar between the two groups (relative risk [RR] 1.02, 95% confidence interval [CI] 0.97–1.08, P=0.403). The cesarean section rate was not different following immediate (16%) versus delayed (22%) oxytocin administration RR 1.4 95% CI 0.8-2.5, p=0.263. The maternal satisfaction on a visual numerical rating scale (median [interquartile range]) was 4 [3–5] and was similar between the two arms. Time to second stage, decision to cesarean delivery, fetal hears rate patterns, APGAR score at one minute and birthweights were similar between the two arms. In the delayed arm, oxytocin infusion was not required for 28% of women.
Immediate or delayed oxytocin administration for hypotonic uterine contractions after amniotomy does not significantly alter the duration of labor, mode of delivery, early neonatal outcomes or maternal satisfaction.
© 2018 Published by Elsevier Inc.