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Oxytocin for induction of labour

Plain language summary


Sometimes it is necessary to bring on labour artificially, because of safety concerns
either for the pregnant woman or her baby.Oxytocin is the most common drug used to
induce labour and has been used either alone, with other drugs or after
artificial ruptureof the membranes. In this review we looked at the use of oxytocin alone
for inducing labour. The review included 61 studies with more than12,000 women.
Overall, oxytocin seems to be a safe method of inducing labour. Compared to waiting to
see whether labour starts naturally (expectant management), giving oxytocin led to more
women having their babies within 24 hours, but more women needed an epidural for
pain relief. Most of the studies recruited women with ruptured membranes and the
number of babies with an infection was lower with oxytocin compared with expectant
management.
A comparison of oxytocin with other drugs to induce labour (vaginal or intracervical
prostaglandins) showed that women were more likely to have their babies within 24
hours with prostaglandin. Fewer women had epidurals with prostaglandin. Side effects
for the mother were similar in the two groups.

Abstract
Background: Oxytocin is the commonest induction agent used worldwide. It has been
used alone, in combination with amniotomy or following cervical ripening with other
pharmacological or nonpharmacological methods.
Objectives: To determine the effects of oxytocin alone for third trimester cervical
ripening and induction of labour in comparison with other methods of induction of labour
or placebo/no treatment.
Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials
Register (January 2009) and bibliographies of relevant papers.
Selection criteria: Randomised and quasirandomised
trials comparing intravenous oxytocin with placebo or no treatment, or with
prostaglandins (vaginal or intracervical) for third trimester cervical ripening or labour
induction.
Data collection and analysis: Two review authors independently assessed eligibility
and carried out data extraction.
Main results: Sixtyone trials (12,819 women) are included.
When oxytocin inductions were compared with expectant management, fewer women
failed to deliver vaginally within 24 hours (8.4% versus 53.8%, risk ratio (RR) 0.16, 95%
confidence interval (CI) 0.10 to 0.25). There was a significant increase in the number of
women requiring epidural analgesia (RR 1.10, 95% CI 1.04 to 1.17). Fewer women were

dissatisfied with oxytocin induction in the one trial reporting this outcome (5.9% versus
13.7%, RR 0.43, 95% CI 0.33 to 0.56).
Compared with vaginal prostaglandins, oxytocin increased unsuccessful vaginal delivery
within 24 hours in the two trials reporting this outcome (70% versus 21%, RR 3.33, 95%
CI 1.61 to 6.89). There was a small increase in epidurals when oxytocin alone was used
(RR 1.09, 95% CI 1.01 to 1.17).
Most of the studies included women with ruptured membranes, and there was some
evidence that vaginal prostaglandin increasedinfection in mothers (chorioamnionitis RR
0.66, 95% CI 0.47 to 0.92) and babies (use of antibiotics RR 0.68, 95% CI 0.53 to 0.87).
These data should be interpreted cautiously as infection was not prespecified in the
original review protocol.
When oxytocin was compared with intracervical prostaglandins, there was an increase in
unsuccessful vaginal delivery within 24 hours (50.4% versus 34.6%, RR 1.47, 95% CI
1.10 to 1.96) and an increase in caesarean sections (19.1% versus 13.7%, RR 1.37,
95% CI 1.08 to 1.74) in the oxytocin group.
Authors' conclusions: Comparison of oxytocin with either intravaginal or intracervical
PGE2 reveals that the prostaglandin agentsprobably increase the chances of achieving
vaginal birth within 24 hours. Oxytocin induction may increase the rate of interventionsin
labour.
A suggestion that for women with prelabour rupture of membranes induction with vaginal
prostaglandin may increase risk ofinfection for mother and baby warrants further study.

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