Pulsatile Versus Continuous Oxytocin for the Augmentation of First Stage of Labour: Randomized Control Study
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- Category: Vol. 85, December 2017
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Pulsatile Versus Continuous Oxytocin for the Augmentation of First Stage of Labour: Randomized Control Study, MOSTAFA A. EBRAHIM, AMR A.M. RIAD and AHMED M.A. TEAMA
Abstract
For the management of delay in the first stage of labour, oxytocin is usually administered as a continuous infusion. However, endogenous oxytocin from the posterior pituitary is not released continuously but as a pulse every three to five minutes. Numerous studies have reported that it is possible that pulsatile administration of oxytocin for dystocia may have advantages over continuous administration.
Aim: The current work aimed to study and compare the effects of pulsatile versus continuous intravenous oxytocin for the augmentation of delayed 1st stage of labor. Also, if there is an increase in the rate of vaginal delivery and reduction in fetal morbidity with the use of pulsatile versus continuous intravenous oxytocin.
Patients and Method: The current study is a randomized controlled study that was conducted in Ain Shams University Maternity Hospital in the prelabour ward at the period from May 2016 till Nov. 2016. 132 patients were studied and classified into 2 groups: Group (1) Pulsatile group: 66 patients were treated with the pulsatile regime in which a programmable syringe pump containing Syntocinon, stock solution: 10 iU/mL was administered for 10 seconds every 6minutes and the dose (2mU/pulse). It was doubled every 30 minutes until uterine contractions are established (3/4 in 10). Group (2) control group: continuous oxytocin augmentation regimen). 66 patients were treated with oxytocin (Syntocinon, stock solution: 10 iU/mL) at starting dose (2mU/min) in a continuous manner doubled every 30 minutes until uterine contractions will be established (3/4 in 10).
Results: Showed that the mean time of augmentation of 1st stage of labor was in the study group (8.95 hours) and in the control group (7 hours) so that pulsatile oxytocin regimen wasn’t as effective as continuous oxytocin regimen in the augmentation of 1st stage of labor. The total dose of oxytocin was much lower in the study group (308.6 MIU) than in the control group (1368.8 MIU).
The failure of vaginal delivery was in the study group 19 cases and in control group 16 cases with no statistically significant difference. As for maternal and neonatal outcomes there was no statistically significant difference as regards maternal admission to the ICU, postpartum hemorrhage, fetal apgar score or admission of neonates to the NICU.
Conclusion: The present study demonstrated that pulsatile oxytocin regimen was less effective than continuous oxytocin regimen in augmentation of the 1st stage of labour with lower total dose of oxytocin and mostly the same maternal and neonatal outcomes.