Amniotomy and Oxytocin for Augmentation of Labour
Condition: Prolonged Labor
Study type: Interventional
Phase: Phase 2

Summary: 
      Prolonged labour is a cause of maternal mortality and morbidity and perinatal mortality and
      morbidity. Prolonged labour is most often defined as onset of regular , rhythmical painful
      contractions accompanied by cervical dilatation where labour is longer than 24
      hours.prolonged active phase should not last longer than 12 hours without full assessment in
      a facility able to offer management and treatment of complications.Causes of prolonged labour
      usually due to poor or uncoordinated uterine action , fetal head malposition , and or
      abnormal pelvis either due to bone or soft tissue obstruction.

      Arrested or prolonged labor is a frequent indication of cesarean delivery.Prolonged labor is
      also associated with increased pain and negative birth experience. Women with a prolonged
      first stage of labor have experienced a higher rate of postpartum hemorrhage,
      chorioamnionitis and neonatal admission to the intensive care unit.

      Caesarean section rates are over 20% in many developed countries and have increased nearly
      four-fold relative to the 5% rate observed in the early 1970s. The main diagnosis
      contributing to this increase is dystocia or prolonged labor.Data obtained from local
      hospital records showed that Caesarean section rate in Assiut University Women's Health
      Hospital is 47.96% at 2013.

      Dystocia is a term used for delay of labor progress and usually refers to abnormally slow
      cervical dilatation.It has been proposed that the partogram should include, as a diagnostic
      criterion, a 1 cm/hour line originating at admission. The World Health Organization has
      proposed a modified partogram that recommends that active phase be diagnosed only at 4 cm or
      more.

      Oxytocin augmentation of uterine contractions with or without amniotomy is widely used in the
      modern obstetric practice to treat a slow labour, although the timing of oxytocin initiation
      and amniotomy may vary widely.This intervention is based on the hypothesis that the most
      frequent cause of dystocia is inadequate uterine contraction.

      The mechanism by which amniotomy speeds up labour remains unclear it is thought that when the
      membranes are ruptured ,the production and release of prostaglandins and oxytocin increases
      resulting in stronger contractions and quicker cervical dilatation. I has been found that
      early intervention (augmentation versus routine care ) with amniotomy and oxytocin to be
      associated with a modest reduction in the risk of caesarean section. Moreover, amniotomy
      found to be associated with an increased risk of cesarean delivery compared with women
      without amniotomy for shortening of spontaneous labour.

      The 3 methods ( Amniotomy, Oxytocin or both) used for augmentation of labor in different
      settings without a real conclusion which is better.
    


Intervention name(s): Amniotomy first; Oxytocin first; Amniotomy and oxytocin; Oxytocin
Intervention type(s): Procedure; Procedure; Procedure; Drug
Intervention description(s): rupture of membranes to augment labor; Administration of oxytocin to augment labor; Rupture of membranes and administration of oxytocin to augment labor
Intervention MeSH terms: Oxytocin
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Labor, prolonged labor, augmentation of labor