Labor induction with continuous low-dose oxytocin infusion: a randomized trial

Article Abstract:

Oxytocin, a hormone released from the pituitary gland, causes the uterus to contract and thereby initiates the process of parturition, or childbirth. This pituitary hormone may be infused to induce labor artificially. Because it is metabolized rapidly, the amounts of oxytocin infused must be increased every 15 to 20 minutes. Studies have shown that oxytocin reaches its effective dose within 30 to 40 minutes of continuous infusion, and drug amounts can be increased at intervals of 30 minutes or more. However, a dosing regimen of oxytocin increased at less than 30-minute intervals continues to be used at several obstetric centers. The outcomes of two regimens of oxytocin to induce labor were compared in 123 women. In one regimen, given to 61 women, doses of oxytocin were increased at intervals of an hour or more. Low doses of oxytocin were administered over a prolonged period to prime the unripe cervix before rupturing the fetal membranes. The conventional regimen, in which oxytocin is given every 20 minutes as needed, was administered to 62 women. In all cases, the fetal membranes were ruptured when conditions were considered safe and feasible. The dose of oxytocin was changed when signs of abnormal fetal heart rate or overstimulation of the uterus developed. Such changes in dose were required by 29 percent of patients receiving the low-dose oxytocin infusion and 58 percent of patients managed by the traditional oxytocin regimen. The regimen of low-dose oxytocin infusion did not significantly increase the time to delivery. The group of patients receiving the traditional oxytocin regimen underwent more cesarean sections. These findings show that continuous low-dose oxytocin infusion is effective in inducing labor and achieving vaginal delivery, and is associated with a lower incidence of overstimulation of the uterus. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Dose-response relationship (Biochemistry), Dose-response relationship

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Efficacy of different starting doses of oxytocin for induction of labor

Article Abstract:

Oxytocin is a hormone administered to induce labor; it can be given at three different concentrations. To evaluate the effects of the agent at 2, 5, or 10 units per liter, clinical experiences with 1,020 obstetrical patients at one hospital in Australia were reviewed retrospectively. Several factors relevant to the mother and the delivery were reviewed, including the number of previous births, the starting concentration of oxytocin, the total dose given, the route of delivery, and the infants' Apgar scores (a measure of physical function in newborns). Results showed that concentrations of oxytocin that were lower than the hospital's standard dose (10 units per liter) were used in almost 44 percent of the cases, most often in patients whose labor had progressed farther. Conversely, patients whose labor was not as advanced tended to receive higher doses. For women delivering their first child, the one-minute Apgar score was lower after 10 units/liter than after 5 units/liter; for women with a previous delivery or deliveries, it was lower after 10 units/liter than after either 5 or 2 units/liter. Since oxytocin at higher doses can cause complications, it is preferable to use the lowest effective dose. The results indicate that no advantage is associated with the use of higher doses; indeed, decreased fetal well-being seems a possible consequence. (Consumer Summary produced by Reliance Medical Information, Inc.)

Drug therapy

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Oxytocin augmentation of labor and perinatal outcome in nulliparas

Article Abstract:

Oxytocin is a hormone released by the pituitary gland. It causes contraction of the uterus and helps to induce labor. This hormone has been used to induce and help the progression of labor. Careless use of oxytocin may result in excessive stimulation of the uterus and reduced oxygen supply to the fetus. However, when used appropriately, oxytocin shortens labor and reduces the incidence of cesarean section for difficult labor without damaging the fetus. Oxytocin may be given according to different regimens, which vary in starting dose, interval between doses, and the rate at which the dose is increased. The effect of high doses of oxytocin in enhancing labor was assessed among 1,080 women in their first pregnancy. Oxytocin was initially injected at a rate of six milliunits per minute (mU/minute). The dose was increased every 15 minutes by 6 mU/minute up to a maximum dose of 40 mU/minute. The outcome of labor and condition of the infant were examined in a group of 456 women who received this drug regimen and in 624 women with an uncomplicated labor. The incidence of birth asphyxia (a condition resulting from inadequate oxygen supply) or other birth-related disabilities was similar in both groups. These findings show that high initial doses of oxytocin can be used to augment labor without causing birth-related complications. (Consumer Summary produced by Reliance Medical Information, Inc.)

Management, Causes of, Physiological aspects, Birth defects, Labor (Obstetrics), Labor, Complicated, Labor complications

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