Nipple stimulation for labor augmentation

A randomized, prospective study was undertaken to evaluate the efficacy of nipple stimulation with a breast pump as compared to oxytocin for augmentation of labor. The average and maximal uterine activity achieved was significantly higher in the oxytocin-stimulated group, without significant differences in the length of labor stages, cesarean section rate, Apgar scores or umbilical artery pH. Fifty percent of the patients failed to respond to nipple stimulation after 30 minutes and were switched to oxytocin. These patients experienced a more rapid rate of cervical dilation in the active phase and reached higher maximal uterine activity with oxytocin stimulation; however, the cesarean section rate was highest in this group. Nipple stimulation with a breast pump appears to be a safe and effective alternative to oxytocin for the augmentation of labor.     

Management of spontaneous rupture of the membranes in the absence of labor in primigravid women at term

One hundred and thirty-five healthy primigravid women at or near term with spontaneous rupture of the membranes without uterine contractions were submitted to a prospective trial of management. Rupture of the membranes was diagnosed by speculum examination. If labor did not commence, induction was performed by oxytocin infusion starting at 9 AM following admission. One hundred and five women went into labor spontaneously before induction became necessary. Sixty-three of these women required augmentation with oxytocin. Twenty-seven percent of the induced group required cesarean section delivery compared to 10% of those in spontaneous labor augmented by oxytocin and to none of those who did not require oxytocin (p less than 0.01). Ninety-four percent of those in spontaneous labor were delivered vaginally compared to 73% of the induced group (p less than 0.01). Forty-one percent of the augmented group were delivered by forceps. Awaiting the spontaneous onset of labor for 24 hours or less did not result in clinical maternal or neonatal infection. We would therefore advocate awaiting the spontaneous onset of labor after spontaneous rupture of membranes without contractions at or near term in healthy primigravid women for up to 24 hours because it seems to confer significant advantages without producing any additional hazard.     

Minimum oxytocin dose requirement after cesarean delivery for labor arrest

OBJECTIVE: To estimate the minimum effective intravenous dose of oxytocin required for adequate uterine contraction after cesarean delivery for labor arrest. METHODS: A randomized single-blinded study was undertaken in 30 parturients undergoing cesarean deliveries under epidural anesthesia for labor arrest despite intravenous oxytocin augmentation. Oxytocin was administered as a slow intravenous bolus immediately after delivery of the infant, according to a biased coin up-down sequential allocation scheme. After assisted spontaneous delivery of the placenta, the obstetrician, blinded to the oxytocin dose, assessed uterine contraction as either satisfactory or unsatisfactory. Additional boluses of oxytocin were administered as required, followed by a maintenance infusion. Data were interpreted and analyzed by a logistic regression model at 95% confidence intervals. RESULTS: All patients received oxytocin infusions at a mean +/- standard deviation of 9.8 +/- 6.3 hours before cesarean delivery (maximum infusion dose 10.3 +/- 8.2 mU/min). The minimum effective dose of oxytocin required to produce adequate uterine response in 90% of women (ED90) was estimated to be 2.99 IU (95% confidence interval 2.32-3.67). The estimated blood loss was 1,178 +/- 716 mL. CONCLUSION: Women requiring cesarean delivery for labor arrest after oxytocin augmentation require approximately 3 IU rapid intravenous infusion of oxytocin to achieve effective uterine contraction after delivery. This dose is 9 times more than previously reported after elective cesarean delivery in nonlaboring women at term, suggesting oxytocin receptor desensitization from exogenous oxytocin administration during labor. Therefore, alternative uterotonic agents, rather than additional oxytocin, may achieve superior uterine contraction and control of blood loss during cesarean delivery for labor arrest. LEVEL OF EVIDENCE: I.     

Acupuncture administered after spontaneous rupture of membranes at term significantly reduces the length of birth and use of oxytocin. A randomized controlled trial

BACKGROUND: The objective was to investigate whether acupuncture could be a reasonable option for augmentation in labor after spontaneous rupture of membranes at term and to look for possible effects on the progress of labor. METHODS: In a randomized controlled trial 100 healthy parturients, with spontaneous rupture of membranes at term, were assigned to receive either acupuncture or no acupuncture. The main response variables were the duration of active labor, the amount of oxytocin given, and number of inductions. RESULTS: Duration of labor was significantly reduced (mean difference 1.7 h, p=0.03) and there was significant reduction in the need for oxytocin infusion to augment labor in the study group compared to the control group (odds ratio 2.0, p=0.018). We also discovered that the participants in the acupuncture group who needed labor induction had a significantly shorter duration of active phase than the ones induced in the control group (mean difference 3.6 h, p=0.002). These findings remained significant also when multiple regression was performed, controlling for potentially confounding factors like parity, epidural analgesia, and birth weight. CONCLUSION: Acupuncture may be a good alternative or complement to pharmacological methods in the effort to facilitate birth and provide normal delivery for women with prelabor rupture of membranes.     

Uterine rupture during induced or augmented labor in gravid women with one prior cesarean delivery.

OBJECTIVE: Our purpose was to examine the risk of uterine rupture during induction or augmentation of labor in gravid women with 1 prior cesarean delivery. STUDY DESIGN: The medical records of all gravid women with history of cesarean delivery who attempted a trial of labor during a 12-year period at a single center were reviewed. The current analysis was limited to women at term with 1 prior cesarean delivery and no other deliveries. The rate of uterine rupture in gravid women within that group undergoing induction was compared with that in spontaneously laboring women. The association of oxytocin induction, oxytocin augmentation, and use of prostaglandin E(2) gel with uterine rupture was determined. Logistic regression analysis was used to examine these associations, with control for confounding factors. RESULTS: Of 2774 women in the analysis, 2214 had spontaneous onset of labor and 560 women had labor induced with oxytocin or prostaglandin E(2) gel. The overall rate of rupture among all patients with induction of labor was 2.3%, in comparison with 0.7% among women with spontaneous labor (P =.001). Among 1072 patients receiving oxytocin augmentation, the rate of uterine rupture was 1.0%, in comparison with 0.4% in nonaugmented, spontaneously laboring patients (P =.1). In a logistic regression model with control for birth weight, use of epidural, duration of labor, maternal age, year of delivery, and years since last birth, induction with oxytocin was associated with a 4.6-fold increased risk of uterine rupture compared with no oxytocin use (95% confidence interval, 1.5-14.1). In that model, augmentation with oxytocin was associated with an odds ratio of 2.3 (95% confidence interval, 0.8-7.0), and use of prostaglandin E(2) gel was associated with an odds ratio of 3.2 (95% confidence interval, 0.9-10.9). These differences were not statistically significant. CONCLUSION: Induction of labor with oxytocin is associated with an increased rate of uterine rupture in gravid women with 1 prior uterine scar in comparison with the rate in spontaneously laboring women. Although the rate of uterine rupture was not statistically increased during oxytocin augmentation, use of oxytocin in such cases should proceed with caution.     

Maternal and neonatal outcomes after oxytocin augmentation in patients undergoing a trial of labor after prior cesarean delivery.

OBJECTIVE: To study the safety of oxytocin augmentation in patients having abnormal labors after a prior cesarean delivery. METHODS: We retrospectively analyzed a case series of women undergoing a trial of labor after a previous cesarean delivery from the University of California San Francisco perinatal data base. Women whose labors were augmented with oxytocin were compared to women with labor abnormalities managed without the use of oxytocin. A wide range of maternal and neonatal outcomes was compared. Only vertex singleton term deliveries were studied. RESULTS: From 1975-1990 there were 504 trials of labor, of which 185 (37%) had labor abnormalities; 62 of these 185 (34%) were augmented with oxytocin. Fifty-eight percent of the trials of labor ended in vaginal delivery. In patients since 1982, 73% delivered vaginally. Forty-six (74%) of augmented patients delivered vaginally. There were no maternal deaths, uterine ruptures, or hysterectomies. Estimated blood loss was slightly greater among augmented patients after controlling for mode of delivery (P < .05), but only by 50-100 mL on average. There was no difference in the need for maternal transfusion. Fetal trauma and fetal scalp blood sampling occurred more frequently (P < .05) in the augmented labors, but only in the subgroup delivered by cesarean. No increased risk was demonstrated by a comparison between patients receiving oxytocin and epidural anesthesia and patients with labor abnormalities receiving neither. CONCLUSION: Retrospective analysis supports the use of oxytocin and epidural anesthesia to augment abnormal trials of labor after prior cesarean.     

Use of magnesium sulfate to treat hyperstimulation in term labor

Magnesium sulfate has been shown in vivo and in vitro to decrease the frequency of uterine contractions while maintaining the amplitude; we therefore decided to assess the use of magnesium sulfate infusion in cases of uterine hyperstimulation. The medical records were reviewed retrospectively for 37 term pregnant patients diagnosed as having uterine hyperstimulation during labor. None of them had medical or obstetric complications. Twenty-two of them received oxytocin augmentation for abnormal labor. Although the vast majority of these patients had a decrease of the hyperstimulation while being given the magnesium, 31.8% in the group receiving oxytocin alone (P less than .05). Fifteen additional patients received magnesium sulfate for uterine hyperstimulation although they were not receiving oxytocin; of these, 16.7% required cesarean delivery. This rate was no different from that of the patients who required labor augmentation, but was double the overall primary cesarean rate at our hospital. There appears to be a group of patients with abnormal uterine activity (either spontaneous or associated with oxytocin augmentation) that responds to treatment with magnesium sulfate.     

A prospective randomized trial of labor induction with vaginal controlled-release dinoprostone inserts with or without oxytocin and misoprostol+oxytocin

OBJECTIVE: This study was designed in an aim to compare the efficacies of three labor induction methods, dinoprostone (PGE2) vaginal insert with or without concomittant oxytocin and misoprostol (PGE1) combined with oxytocin infusion. METHODS: This was a prospective observational trial of nulliparous women undergoing labor induction from December 2006 to January 2007. Inclusion criteria were: gestational age between 36 to 42 weeks, singleton cephalic presentation of the fetus, intact membrane and unfavorable cervical Bishop score < 6, and absence of spontaneous uterine contractions. Participants were then randomly assigned to preinduction cervical ripening with a dinoprostone vaginal insert (10 mg) administered into the posterior fornix for a total of 12 hours without oxytocin (group I); with oxytocin (group II), and with misoprostol (50 microg) intravaginally in the posterior fornix with repeat dosing at 6-hour intervals with a maximum dose of four with oxytocin (group III). RESULTS: A total number of 106 women met the inclusion criteria without distribution for 19 cases in group I, 44 and 43 cases in groups II and III, respectively. There were no statistically significant differences in terms of the demographic characteristics, indication of labor induction, interval from-induction-to-delivery, cardiotocographic abnormalities and neonatal outcomes and mode of deliveries among the three groups (p > 0.05). CONCLUSIONS: Three methods of labor induction were equally efficient in achieving succesful delivery without any maternal and fetal adverse outcomes.     

Uterine contraction pressures with oxytocin induction/augmentation

Uterine contraction pressures were quantified (in Montetevideo units) in 109 women at term gestation who received oxytocin for induction or augmentation of labor and whose labor resulted in a spontaneous vaginal delivery. Newborn five-minute Apgar scores were greater than or equal to 8 in 108 of the 109 neonates, and no immediate neonatal morbidity was attributable to the oxytocin stimulation of labor. Women undergoing oxytocin induction had significantly greater uterine contraction pressures than those with oxytocin augmentation. During oxytocin induction 91% of women achieved at least 200 to 224 Montevideo Units and 40% at least 300 Montevideo units versus 77 and 7.7%, respectively, during augmentation of labor. With concurrent fetal monitoring these levels of uterine activity should be sought before consideration of a cesarean delivery because of presumed cephalopelvic disproportion or failure to progress.     

Labor course and delivery in epidural analgesia: a case-control study.

BACKGROUND: We aimed to establish if epidural analgesia is associated with a higher incidence of operative vaginal delivery, longer duration of labor and more frequent use of oxytocin than labor without analgesia. METHODS: We analyzed a cohort of 207 women with no risk factors who delivered with epidural analgesia in the labor unit of Spedali Civili, Brescia, Italy, during 2001. Length of the first and second stage of labor, mode of delivery, neonatal cord blood pH, neonatal Apgar score and neonatal outcomes were evaluated. RESULTS: Epidural analgesia was performed on request in 6%: in this group (group A) there were 141 (68%) nulliparae and 66 (32%) pluriparae; mean ( +/- standard deviation) gestational age at delivery was 39.4 +/- 1.3 weeks (range: 34.1-41.5 weeks). In this group, 184 (89%) had vaginal delivery and 23 (11%) delivered by Cesarean section. Among controls (group B), 368 (89%) had a vaginal delivery and 46 (11%) delivered by Cesarean section; vacuum extraction was used in 18 deliveries (9%) in group A and in 13 deliveries (3%) in group B. The duration of the second stage of spontaneous labor in the nulliparae of group A was significantly longer than in group B. No statistically significant differences were found between mean umbilical artery pH values of groups A and B. CONCLUSION: Our results confirm that epidural analgesia does not affect the rate of Cesarean delivery, while increasing the use of oxytocin augmentation, the duration of the second stage of labor and the rate of instrumental vaginal delivery.     

Randomized, double-masked comparison of oxytocin dosage in induction and augmentation of labor.

OBJECTIVE: To test the hypothesis that high-dose oxytocin, when used in a masked fashion, would result in shorter labors and less need for cesarean delivery. METHODS: We conducted randomized, double-masked trials of high-dose compared with low-dose oxytocin for augmentation and induction of labor. Patients were randomly assigned to receive oxytocin by either a low-dose protocol (1.5 mU/minute initially, increased by 1.5 mU/minute every 30 minutes) or a high-dose protocol (4.5 mU/minute initially, increased by 4.5 mU/minute every 30 minutes). Oxytocin solutions were prepared by a central pharmacy and infusion volumes (mL/hour) were identical, thus ensuring double masking. RESULTS: A total of 1307 patients were randomized (induction, 816; augmentation, 491). In the group receiving oxytocin for induction, high-dose oxytocin was associated with a significant shortening of labor (oxytocin to complete dilatation: 9.7+/-0.3 compared with 7.8+/-0.2 hours, P<.001; oxytocin to delivery: 10.5+/-0.3 compared with 8.5+/-0.3 hours, P<.001). The cesarean delivery rate with low-dose oxytocin was 15.0%, compared with 11.3% with high-dose oxytocin (P = .17). For nulliparous women undergoing induction, cesarean delivery rates were as follows: Total 17.3% (low dose) compared with 11.7% (high dose), P = .15; cephalopelvic disproportion 11.9% (low dose) compared with 5.9% (high dose), P = .06. When used for augmentation, high-dose oxytocin again was associated with a significant shortening of labor without a significant difference in cesarean birth rates. No differences in neonatal outcomes were noted between the groups for either augmentation or induction. CONCLUSION: When used in a double-masked fashion, high-dose oxytocin is associated with significantly shorter labors without any demonstrable adverse fetal or neonatal effects.     

Predictors of vaginal delivery in patients with a previous cesarean section, who require oxytocin

Prospective analysis of 98 consecutive patients at term pregnancy with one previous cesarean section, who received oxytocin during a trial of labor (34 inductions, 64 augmentations), was undertaken to identify specific factors associated with successful vaginal delivery. The overall vaginal delivery rate was 59.2%. Comparing route of delivery in the induction and augmentation groups separately revealed no significant differences in maternal height, weight, or parity, duration of membrane rupture, length of oxytocin treatment or maximum dose, cervical examination on admission or before oxytocin treatment, or use of conduction anesthesia. A previous vaginal delivery favored repeat vaginal delivery in patients with augmentation while a nonrecurrent indication was significantly associated with vaginal delivery in all patients. After the beginning of oxytocin augmentation, the cervical dilatation rate was 1.82 cm/hr in patients delivered vaginally, compared with 0.18 cm/hr in those requiring cesarean section (p less than 0.001). Any cervical dilatation during the first 2 hours of augmentation was associated with more frequent vaginal delivery: 24 of 40 vaginal deliveries (60%) versus six of 24 cesarean sections (25%, p less than 0.01). Discriminant analysis correctly identified route of delivery in 85.3% of those with induction and 87.5% of patients with augmentation. During a trial of labor, oxytocin induction or augmentation is effective in a majority of patients. Furthermore, an early response during augmentation is of predictive value when such patients are being managed.     

Plasma oxytocin levels in women during labor with or without epidural analgesia: a prospective study

BACKGROUND: Epidural analgesia (EDA) has been reported to prolong labor. Whether this is by interference with endogenous oxytocin release or other mechanisms is unclear. With increasing numbers of women receiving an EDA, it is important to study its effects on labor. The aim was to study the concentration of plasma oxytocin and the progress of labor in women with and without EDA. METHODS: Thirty-four full-term women in spontaneous labor were included, 17 with epidural and 17 controls, matched for cervical dilatation and parity. Oxytocin was measured by radioimmunoassay before analgesia, 60 min later and after placental discharge. No oxytocin augmentation was given during the first hour. RESULTS: EDA during labor was associated with a fall in plasma oxytocin. There was no difference in plasma oxytocin levels between the groups at inclusion. One hour later, oxytocin concentrations had decreased in the epidural and increased in the control group (Student's t-test, p = 0049). The change in oxytocin levels between the first and second sample differed significantly between the groups (ancova, p = 0.028). No difference in cervix dilatation between the groups 1 h after inclusion was noted, but women with EDA had a longer labor compared with those without, especially those with epidural and oxytocin augmentation during the later phase of the first stage of labor. CONCLUSION: EDA during labor may interfere with the release of plasma oxytocin, which may be one mechanism behind prolongation of labor. Larger studies are needed to clarify the effects of epidural analgesia and the role of oxytocin during labor.     

Pulsatile administration enhances the effect and reduces the dose of oxytocin required for induction of labor

Pulsatile administration of oxytocin was compared with continuous infusion of oxytocin for induction of labor in pregnant rats. The dosages consisted of intravenous injections of 0, 2.5, and 5 mU oxytocin every 10 minutes and intravenous infusion of 1 mU/minute of oxytocin in 0.9% sodium chloride. These doses are within the range of endogenously secreted pulses. All treatments began on day 22 at 2 p.m. and continued for 8 hours. Pulsatile administration resulted in a marked reduction in the dose of oxytocin required to induce labor. Using 5 mU pulses, birth was induced with 18.4%, and using 2.5 mU pulses, with 24% of the dose needed using continuous infusion. Parturition was advanced by 12 hours on the average by oxytocin treatment, but no significant differences were observed between the various oxytocin dosage regimens in this regard or in regard to gestation length, induction-delivery interval, duration of delivery, or the proportion of living or dead pups. Significantly more uterine activity was induced with each mU of oxytocin using pulsatile administration than using continuous infusion. There was no evidence for down-regulation of oxytocin receptors during a continuous infusion of oxytocin. We postulate that the greater efficacy of oxytocin pulses to induce uterine activity and delivery in comparison to continuous infusions is due to a more effective stimulation of prostaglandin F2 alpha release from the decidua. The amount of oxytocin needed for induction of labor with 2.5 mU pulses was similar to the decrease in neurohypophyseal oxytocin content during the first stage of spontaneous labor, and uterine activity elicited was also similar to that observed during spontaneous labor.(ABSTRACT TRUNCATED AT 250 WORDS)     

Induction of labor with an electric breast pump

Nipple stimulation with an electric breast pump was compared with oxytocin infusion as a means of labor induction. The time from stimulation to the onset of regular uterine activity and to 200 Montevideo units of uterine activity and the time until entrance into the active phase of labor were significantly shorter in the nipple stimulation group. Once the women were in active labor, there was no difference between the groups in the length of labor or mode of delivery.     

Epidural analgesia in association with duration of labor and mode of delivery: a quantitative review

OBJECTIVE: This study was undertaken to quantitatively summarize previous literature on the effects of epidural analgesia in labor on the duration of labor and mode of delivery. STUDY DESIGN: Original studies published in English from 1965 through December 1997 were reviewed and assigned a quality score independently by 2 of the authors. Studies that met the minimal requirements were evaluated further. Data syntheses were performed separately according to study design and outcome measurements, including cesarean delivery, instrumental delivery, oxytocin augmentation, and durations of the first and second stages of labor. RESULTS: Seven randomized clinical trials and 5 observational studies met the minimal requirements. Among them 4 studies of each sort were included in the data synthesis. Both types of studies showed that epidural analgesia increased risk of oxytocin augmentation 2-fold. Clinical trials suggested that epidural analgesia did not increase the risk of cesarean delivery either overall or for dystocia, nor did it significantly increase the risk of instrumental vaginal delivery; however, observational studies reported a more than 4-fold increased risk of cesarean and instrumental deliveries. Although most studies showed a longer labor among women with epidural analgesia than without it, especially during the second stage, most of the studies used inappropriate statistical analysis. CONCLUSION: Epidural analgesia with low-dose bupivacaine may increase the risk of oxytocin augmentation but not that of cesarean delivery.     

Labor characteristics of uncomplicated prolonged pregnancies after induction with intracervical prostaglandin E2 gel versus intravenous oxytocin.

Labor characteristics after intracervical application of 0.5 mg prostaglandin (PG) E2 gel (n = 83) versus intravenous administration of oxytocin (n = 82) for labor induction were investigated in uncomplicated prolonged pregnancies with unripe cervix. The induction to delivery time as well as the total oxytocin dose were significantly reduced in the PGE2 group (p < 0.001). Cesarean sections, instrumental deliveries and fetal distress had the same frequency, but the failures of trial were significantly higher in the oxytocin group than in the PGE2 group (20.7 vs. 6%, p < 0.01). Twenty-four percent of women needed a second PGE2 dose, and almost half of the women in the PGE2 group experienced 'spontaneous' labor. More neonates in the oxytocin group had 5-min Apgar scores < 7 (p < 0.05). Intracervical PGE2 gel application is superior to intravenous oxytocin in terms of shortening the induction-delivery interval and increasing the frequency of successful vaginal delivery. In addition, it is safe for mother and fetus.     

Rate of increase in oxytocin dose on the outcome of labor induction.

OBJECTIVE: To compare the efficacy and safety of arithmetic and geometric increases in oxytocin infusion dosage during induction of labor. METHODS: A total of 120 pregnant women requiring induction of labor at term were randomly assigned to receive oxytocin at dosages increasing arithmetically or geometrically. Maternal demographics, labor delivery data, and newborn outcomes were compared. The setting was the maternity unit of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. RESULTS: The mean maximum rates of oxytocin delivery needed to achieve adequate uterine contractions were similar in the 2 groups (24.66+/-8.34 mU/min vs. 26.38+/-8.77 mU/min, P=0.24). Labor duration was significantly shorter in the geometric progression group (496.33+/-54.77 min vs. 421.34+/-63.91 min, P<0.001). There were no differences in the rates of cesarean sections, vaginal deliveries, or uterine hyperstimulation, or in neonatal outcomes. CONCLUSION: A geometric rise in the rate of oxytocin infusion delivery reduced the duration of labor without affecting the rates of cesarean sections and uterine hyperstimulation, or newborn outcomes.     

Maternal mean corpuscle volume and oxytocin augmentation during vaginal delivery

Objective: The aim of this study was to assess whether low maternal MCV values are associated with adverse course of vaginal delivery. Study design: A retrospective analysis of 92 consecutive vertex singleton vaginal deliveries in nulliparous women in a university tertiary health care facility. MCV was considered as major outcome variable. Results: 54.1% of Parturients with higher MCV needed oxytocin augmentation during labor as compared to 79.5% of parturients with lower MCV (P<0.05). The need for oxytocin for augmentation of labor was decreased with larger MCV (OR 0.90 per fL, 95% CI 0.82–0.98, P<0.05). No correlation was found between MCV and other parameters of labor course. Conclusion: Low maternal MCV values were associated with increased use of oxytocin augmentation during vaginal delivery.     

Early versus delayed oxytocin augmentation in nulliparous women with prolonged labour—a randomised controlled trial

Objective  To study the effects of early versus delayed oxytocin augmentation on the obstetrical and neonatal outcome in nulliparous women with spontaneous but prolonged labour.
Design  Randomised controlled study.
Setting  Two delivery units in Sweden.
Population  Healthy nulliparous women with normal pregnancies, spontaneous onset of active labour, a cervical dilatation of 4–9 cm and no progress in cervical dilatation for 2 hours and for an additional hour if amniotomy was performed due to slow progress.
Methods  Women ( n = 630) were randomly allocated either to labour augmentation by oxytocin infusion (early oxytocin group) or to postponement of oxytocin augmentation for another 3 hours (expectant group).
Main outcome measure  Mode of delivery (spontaneous vaginal or instrumental vaginal delivery or caesarean section) and time from randomisation to delivery.
Results  The caesarean section rate was 29 of 314 (9%) in the early oxytocin group and 34 of 316 (11%) in the expectant group (OR 0.8, 95% CI 0.5–1.4), and instrumental vaginal delivery 54 of 314 (17%) in the early oxytocin versus 38 of 316 (12%) in the expectant group (OR 1.5, 95% CI 0.97–2.4). Early initiation of oxytocin resulted in a mean decrease of 85 minutes in the randomisation to delivery interval.
Conclusion  Early administration of oxytocin did not change the rate of caesarean section or instrumental vaginal delivery but shortened labour duration significantly in women with a 2-hour arrest in cervical dilatation. No other clear benefits or harms were seen between early and delayed administration of oxytocin.