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Intravenous oxytocin alone for cervical ripening and induction of labour (Review)
Copyright 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
[Intervention Review]
Contact address: Zarko Alfirevic, School of Reproductive and Developmental Medicine, Division of Perinatal and Reproductive
Medicine, The University of Liverpool, First Floor, Liverpool Womens NHS Foundation Trust, Crown Street, Liverpool, L8 7SS, UK.
zarko@liverpool.ac.uk.
Citation: Alfirevic Z, Kelly AJ, Dowswell T. Intravenous oxytocin alone for cervical ripening and induction of labour. Cochrane
Database of Systematic Reviews 2009, Issue 4. Art. No.: CD003246. DOI: 10.1002/14651858.CD003246.pub2.
Copyright 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
ABSTRACT
Background
Oxytocin is the commonest induction agent used worldwide. It has been used alone, in combination with amniotomy or following
cervical ripening with other pharmacological or non-pharmacological methods.
Objectives
To determine the effects of oxytocin alone for third trimester cervical ripening and induction of labour in comparison with other
methods of induction of labour or placebo/no treatment.
Search methods
We searched the Cochrane Pregnancy and Childbirth Groups Trials Register (January 2009) and bibliographies of relevant papers.
Selection criteria
Randomised and quasi-randomised trials comparing intravenous oxytocin with placebo or no treatment, or with prostaglandins (vaginal
or intracervical) for third trimester cervical ripening or labour induction.
Data collection and analysis
Two review authors independently assessed eligibility and carried out data extraction.
Main results
Sixty-one trials (12,819 women) are included.
When oxytocin inductions were compared with expectant management, fewer women failed to deliver vaginally within 24 hours (8.4%
versus 53.8%, risk ratio (RR) 0.16, 95% confidence interval (CI) 0.10 to 0.25). There was a significant increase in the number of
women requiring epidural analgesia (RR 1.10, 95% CI 1.04 to 1.17). Fewer women were dissatisfied with oxytocin induction in the
one trial reporting this outcome (5.9% versus 13.7%, RR 0.43, 95% CI 0.33 to 0.56).
Intravenous oxytocin alone for cervical ripening and induction of labour (Review)
Copyright 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Compared with vaginal prostaglandins, oxytocin increased unsuccessful vaginal delivery within 24 hours in the two trials reporting this
outcome (70% versus 21%, RR 3.33, 95% CI 1.61 to 6.89). There was a small increase in epidurals when oxytocin alone was used
(RR 1.09, 95% CI 1.01 to 1.17).
Most of the studies included women with ruptured membranes, and there was some evidence that vaginal prostaglandin increased
infection in mothers (chorioamnionitis RR 0.66, 95% CI 0.47 to 0.92) and babies (use of antibiotics RR 0.68, 95% CI 0.53 to 0.87).
These data should be interpreted cautiously as infection was not pre-specified in the original review protocol.
When oxytocin was compared with intracervical prostaglandins, there was an increase in unsuccessful vaginal delivery within 24 hours
(50.4% versus 34.6%, RR 1.47, 95% CI 1.10 to 1.96) and an increase in caesarean sections (19.1% versus 13.7%, RR 1.37, 95% CI
1.08 to 1.74) in the oxytocin group.
Authors conclusions
Comparison of oxytocin with either intravaginal or intracervical PGE2 reveals that the prostaglandin agents probably increase the
chances of achieving vaginal birth within 24 hours. Oxytocin induction may increase the rate of interventions in labour.
A suggestion that for women with prelabour rupture of membranes induction with vaginal prostaglandin may increase risk of infection
for mother and baby warrants further study.
Intravenous oxytocin alone for cervical ripening and induction of labour (Review)
Copyright 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.