Oxytocin augmentation of labour in women with epidural analgesia for reducing operative deliveries (Review)

Costley, Philippa L. and East, Christine E. (2013) Oxytocin augmentation of labour in women with epidural analgesia for reducing operative deliveries (Review). Cochrane Database of Systematic Reviews, 2013 7: CD009241.1-CD009241.24. doi:10.1002/14651858.CD009241.pub3

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Author Costley, Philippa L.
East, Christine E.
Title Oxytocin augmentation of labour in women with epidural analgesia for reducing operative deliveries (Review)
Journal name Cochrane Database of Systematic Reviews   Check publisher's open access policy
ISSN 1469-493X
Publication date 2013-07-11
Year available 1991
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1002/14651858.CD009241.pub3
Open Access Status File (Publisher version)
Volume 2013
Issue 7
Start page CD009241.1
End page CD009241.24
Total pages 24
Place of publication Oxford, United Kingdom
Publisher John Wiley & Sons
Language eng
Formatted abstract
Background The rate of operative deliveries (both caesarean sections, vacuum extractions and forceps), continues to rise throughout the world. These are associated with significant maternal and neonatal morbidity. The most common reasons for operative births in nulliparous women are labour dystocia (failure to progress), and non-reassuring fetal status. Epidural analgesia has been shown to slow the progress of labour, as well as increase the rate of instrumental deliveries. However, it is unclear whether the use of oxytocin in women with epidural analgesia results in a reduction in operative deliveries, and thereby reduces both maternal and fetal morbidity.

Objectives To determine whether augmentation of women using epidural analgesia with oxytocin will decrease the incidence of operative deliveries and thereby reduce fetal and maternal morbidity.

Search methods We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 June 2013).

Selection criteria All published and unpublished randomised and quasi-randomised trials that compared augmentation with oxytocin of women in spontaneous labour with epidural analgesia versus intent to manage expectantly were included. Cluster-randomised trials were eligible for inclusion but none were identified.

Cross-over study designs were unlikely to be relevant for this intervention, and we planned to exclude them if any were identified. We did not include results that were only available in published abstracts.

Data collection and analysis The two review authors independently assessed for inclusion the 16 studies identified as a result of the search strategy. Both review authors independently assessed the risk of bias for each included study. Both review authors independently extracted data. Data were checked for accuracy.

Main results We included two studies, involving 319 women. There was no statistically significant difference between the two groups in either of the primary outcomes of caesarean section (risk ratio (RR) 0.95, 95% confidence interval (CI) 0.42 to 2.12) or instrumental delivery (RR 0.88, 95% CI 0.72 to 1.08). Similarly, there were no statistically significant differences between the two groups in any of the secondary outcomes for which data were available. This included Apgar score less than seven at five minutes (RR 3.06, 0.13 to 73.33), admission to neonatal intensive care unit (RR 1.07, 95% CI 0.29 to 3.93), uterine hyperstimulation (RR 1.32, 95% CI 0.97 to 1.80) and postpartum haemorrhage (RR 0.96, 95% CI 0.58, 1.59).

Authors' conclusions There was no statistically significant difference identified between women in spontaneous labour with epidural analgesia who were augmented with oxytocin, compared with those who received placebo. However, due to the limited number of women included in the studies, further research in the form of randomised controlled trials are required.

Plain language summary: Oxytocin for reducing operative births in women with epidurals in labour
The rate of operative births (caesarean sections, forceps and vacuum extraction) continues to rise throughout the world. All three types of delivery are associated with significant complications for both the mother and her baby such as traumatic birth injuries, increased blood loss and placental complications in future pregnancies. One of the most common reasons for a woman to require an operative birth is because the labour does not progress adequately. Increasingly, epidurals are used to manage the pain during labour, however, epidurals may also slow the progression of labour. Oxytocin is a hormone that stimulates uterine contractions in labour and is given to women who are slow to progress in labour. By giving oxytocin to all women with epidurals during labour, the rate of operative deliveries, and the associated complications, could be reduced.

Data were collected from two randomised studies (involving 319 women) which compared women with epidurals who were given either oxytocin, or a placebo. The rates of operative deliveries were not clearly different between the two groups There were also no significant differences between the other outcomes analysed, such as the Apgar scores of the newborn babies, admissions to the neonatal nursery, rates of post birth haemorrhage or rates of over stimulation of the uterus. Both studies appeared to have a low risk of bias.

Overall, there was no significant difference between the rates of operative deliveries in women with epidurals who were given oxytocin compared with those who received the placebo. However, as there were limited data available, in order to fully determine whether augmentation of women with epidurals reduces the rate of operative deliveries and therefore reduces the complications associated, further studies are required.
Keyword Anesthesiology
Anesthesiology
ANESTHESIOLOGY
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Non HERDC
School of Nursing, Midwifery and Social Work Publications
 
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Created: Tue, 07 Jan 2014, 23:48:01 EST by Vicki Percival on behalf of School of Nursing, Midwifery and Social Work