Early Versus Delayed Oxytocin Infusion Following Amniotomy in Nulliparous Women
Condition: Delivery Delayed; Mode of Delivery; Post Partum Hemorrhage; Uterine Hyperstimulation
MeSH terms: Postpartum Hemorrhage; Hemorrhage
Study type: Interventional

Summary: 
      In UKM Medical Centre (UKMMC), delayed oxytocin augmentation at two hours following amniotomy
      is the routine obstetric practice in spontaneous or induced labour with intact membranes.
      This practice may potentially cause prolonged labour, extended labour room occupancy and
      increased maternal exhaustion while no additional benefit can be gained. On the other hand,
      recommendation for early oxytocin augmentation poses a dilemma as the effectiveness and
      safety of this practice are still in doubt.

      Given this background, the aim of this study was to compare the effect of early versus delay
      oxytocin infusion in achieving successful vaginal delivery among the low-risk nulliparous
      women in UKMMC. Besides, this study also compares the adverse maternal and neonatal outcomes
      between the two practices.
    

Detailed description: 
      This was a randomised controlled trial undertaken in the labour room of UKMMC for a period of
      eighteen months from August 2014 until February 2016. Eligible women who were admitted in
      spontaneous labour or for induction of labour were recruited. For women who underwent
      induction of labour, an interval of at least six hours following vaginal prostaglandin before
      recruitment was mandatory to avoid overlapping effect of prostaglandin and oxytocin. Upon
      enrolment, each patient was given a study explanation and written consent was obtained.

      The randomisation sequence, either to the early oxytocin group or the delayed oxytocin group,
      was generated using the computer randomisation program in block of two. Allocation to either
      arm of treatment was determined by the sequential opening of sealed numbered envelopes.

      In the first arm of early oxytocin group, labour augmentation with oxytocin was started early
      following artificial ruptured of membrane(ARM). In the second arm of delayed oxytocin group,
      oxytocin augmentation was delayed at two hours after ARM and this practice is currently being
      used as standard protocol in this hospital to manage women in labour. In both arms,the
      infusion rate was doubled every 30 minutes to a maximum of 48 mL/h or until four to five
      moderate contractions per 10 minutes were achieved at which point the infusion rate was
      maintained. Continuous fetal heart rate monitoring was maintained throughout the intrapartum
      period. Vaginal examination was performed at four hours after ARM as well as when clinically
      indicated ie. abnormal cardiotocography (CTG) and maternal desire to bear down. In the
      presence of abnormal CTG, either fetal blood sampling or expedited delivery was undertaken as
      per decided by the obstetrician in charge.
    

Intervention name(s): duration of initiation of oxytocin
Intervention type(s): Other
Intervention description(s): mode of delivery
Intervention MeSH terms: Oxytocin
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: primigravida; amniotomy,; immediate oxytocin; delayed oxytocin