Oxytocin augmentation in labouring patients: less is better

Oxytocin augmentation in labouring patients: less is better Ragusa, A2 ; Svelato, A1 ; Costa, D3 ; Spinoso, R2 ; Perino, A1 1 Department of Obstetrics And Gynecology, University Hospital Paolo Giaccone, Palermo, Italy; 2 Department of Obstetrics and Gynecology, Niguarda Hospital, Milan, Italy; 3 Department of Obstetrics and Gynaecology, Sesto San Giovanni Hospital, Milan, Italy Introduction The purpose of this study was to examine the effects of a conservative and specific checklist, based on a protocol for oxytocin administration on maternal and newborn outcomes in the first Robson’s class patients. Methods This was a retrospective chart review and data extraction conducted at Sesto San Giovanni Hospital, Obstetrical Department, Milan, Italy. We divided the population in two groups: the first composed by women who delivered in first semester of 2010 (before intervention group, BI) and the second group composed by women who delivered in first semester of 2011 (after intervention group, AI). The new protocol used cervix curve progression as monitoring the effectiveness of the drug in the first stage of labor and the progression of fetal head in second stage of labor. Furthermore, in AI group the physicians would have specified the indication when they decided to use oxytocin, but not in BI group. In BI group oxytocyn was administrated at high dosage, while in AI group at low dosage. Cross-tabulations were checked by chi-square or by Fisher’s exact test if needed. Results The rate of oxytocin used for augmentation decreased significantly from 28.1% in BI (72/256 patients; 95% CI: 22.7– 34.1) to 14.2% in AI (47/332 patients; 95% CI: 10.6–18.4) (Fisher’s exact test: P < 0.0001). Oxytocin infusion during only the first stage of labour was significantly lower in AI group (11% vs 28%) (P = 0.02), while augmentation in both stages of labour was significantly higher in AI (30% vs 57%, P = 0.003). The rate of episiotomy was 55% in BI versus 41% in AI (P = 0.002). All the other index of maternal and newborn outcomes were improved in AI group, but the differences did not reach statistical significance. The average length of the labours’ stages in BI vs AI groups does not undergo significant variations. Conclusion Using a standardised protocol, which introduce the need to specify the indications, reduces the use and total amount of oxytocin to augmentation of labor, without changing the times of the same. Use as a sign of efficacy the cervix curve progression and the progression of fetal head, instead of the number of contractions in the unit time (frequency) allows a more selective and effective use of drug. This is the reason of the decrease in full use and the increase in use of labor in both periods. One advantage of the study is that it is focuses on a very select population (first Robson’s class). The limit of this study was the small sample size.