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Meta-Analysis
. 2013 Aug 7;2013(8):CD006794.
doi: 10.1002/14651858.CD006794.pub4.

Early amniotomy and early oxytocin for prevention of, or therapy for, delay in first stage spontaneous labour compared with routine care

Shuqin Wei  1 , Bi Lan Wo, Hui-Ping Qi, Hairong Xu, Zhong-Cheng Luo, Chantal Roy, William D Fraser
Affiliations
Meta-Analysis

Early amniotomy and early oxytocin for prevention of, or therapy for, delay in first stage spontaneous labour compared with routine care

Shuqin Wei et al. Cochrane Database Syst Rev. .

Abstract

Background: Caesarean section rates are over 20% in many developed countries. The main diagnosis contributing to the high rate in nulliparae is dystocia or prolonged labour. The present review assesses the effects of a policy of early amniotomy with early oxytocin administration for the prevention of, or the therapy for, delay in labour progress.

Objectives: To estimate the effects of early augmentation with amniotomy and oxytocin for prevention of, or therapy for, delay in labour progress on the caesarean birth rate and on indicators of maternal and neonatal morbidity.

Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 May 2013), MEDLINE (1966 to 4 July 2013), Embase (1980 to 4 July 2013), CINAHL (1982 to 4 July 2013), MIDIRS (1985 to 4 July 2013) and contacted authors for data from unpublished trials.

Selection criteria: Randomized and quasi-randomized controlled trials that compared oxytocin and amniotomy with expectant management.

Data collection and analysis: Three review authors extracted data independently. We stratified the analyses into 'Prevention Trials' and 'Therapy Trials' according to the status of the woman at the time of randomization. Participants in the 'Prevention Trials' were unselected women, without slow progress in labour, who were randomized to a policy of early augmentation or to routine care. In 'Treatment Trials' women were eligible if they had an established delay in labour progress.

Main results: For the 2013 update, we identified and excluded one new clinical trial. This updated review includes 14 trials, randomizing a total of 8033 women. The unstratified analysis found early intervention with amniotomy and oxytocin to be associated with a modest reduction in the risk of caesarean section; however, the confidence interval (CI) included the null effect (risk ratio (RR) 0.89; 95% CI 0.79 to 1.01; 14 trials; 8033 women). In prevention trials, early augmentation was associated with a modest reduction in the number of caesarean births (RR 0.87; 95% CI 0.77 to 0.99; 11 trials; 7753). A policy of early amniotomy and early oxytocin was associated with a shortened duration of labour (average mean difference (MD) - 1.28 hours; 95% CI -1.97 to -0.59; eight trials; 4816 women). Sensitivity analyses excluding four trials with a full package of active management did not substantially affect the point estimate for risk of caesarean section (RR 0.87; 95% CI 0.73 to 1.05; 10 trials; 5165 women). We found no other significant effects for the other indicators of maternal or neonatal morbidity.

Authors' conclusions: In prevention trials, early intervention with amniotomy and oxytocin appears to be associated with a modest reduction in the rate of caesarean section over standard care.

PubMed Disclaimer

Conflict of interest statement

William D Fraser is the principal investigator of one of the papers in the meta‐analysis.

Figures

1
1
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
2
2
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Early amniotomy and early oxytocin versus routine care on spontaneous labour, Outcome 1 Caesarean section rate.
1.2
1.2. Analysis
Comparison 1 Early amniotomy and early oxytocin versus routine care on spontaneous labour, Outcome 2 Spontaneous vaginal delivery.
1.3
1.3. Analysis
Comparison 1 Early amniotomy and early oxytocin versus routine care on spontaneous labour, Outcome 3 Instrumental vaginal delivery (forceps or vacuum, or both).
1.4
1.4. Analysis
Comparison 1 Early amniotomy and early oxytocin versus routine care on spontaneous labour, Outcome 4 Length of first stage of labour.
1.5
1.5. Analysis
Comparison 1 Early amniotomy and early oxytocin versus routine care on spontaneous labour, Outcome 5 Duration of labour (duration in hours from admission in labour).
1.6
1.6. Analysis
Comparison 1 Early amniotomy and early oxytocin versus routine care on spontaneous labour, Outcome 6 Use of epidural analgesia.
1.7
1.7. Analysis
Comparison 1 Early amniotomy and early oxytocin versus routine care on spontaneous labour, Outcome 7 Hyperstimulation of labour.
1.8
1.8. Analysis
Comparison 1 Early amniotomy and early oxytocin versus routine care on spontaneous labour, Outcome 8 Postpartum haemorrhage (greater than 500 ml).
1.9
1.9. Analysis
Comparison 1 Early amniotomy and early oxytocin versus routine care on spontaneous labour, Outcome 9 Maternal blood transfusion.
1.10
1.10. Analysis
Comparison 1 Early amniotomy and early oxytocin versus routine care on spontaneous labour, Outcome 10 Postpartum fever or infection.
1.11
1.11. Analysis
Comparison 1 Early amniotomy and early oxytocin versus routine care on spontaneous labour, Outcome 11 Apgar score less than seven at five minutes.
1.12
1.12. Analysis
Comparison 1 Early amniotomy and early oxytocin versus routine care on spontaneous labour, Outcome 12 Acidosis as defined abnormal arterial cord pH (pH less than 7.10 or 7.20).
1.13
1.13. Analysis
Comparison 1 Early amniotomy and early oxytocin versus routine care on spontaneous labour, Outcome 13 Suboptimal or abnormal fetal heart tracing.
1.14
1.14. Analysis
Comparison 1 Early amniotomy and early oxytocin versus routine care on spontaneous labour, Outcome 14 Fetal distress.
1.15
1.15. Analysis
Comparison 1 Early amniotomy and early oxytocin versus routine care on spontaneous labour, Outcome 15 Admission to special care nursery.
1.16
1.16. Analysis
Comparison 1 Early amniotomy and early oxytocin versus routine care on spontaneous labour, Outcome 16 Seizure/neurological abnormalities.
1.17
1.17. Analysis
Comparison 1 Early amniotomy and early oxytocin versus routine care on spontaneous labour, Outcome 17 Jaundice or hyperbilirubinemia.
1.18
1.18. Analysis
Comparison 1 Early amniotomy and early oxytocin versus routine care on spontaneous labour, Outcome 18 Satisfied with labour experience.
2.1
2.1. Analysis
Comparison 2 Early amniotomy and early oxytocin versus routine care on spontaneous labour (Sensitivity analyses: active management trials excluded), Outcome 1 Caesarean section rate.
2.2
2.2. Analysis
Comparison 2 Early amniotomy and early oxytocin versus routine care on spontaneous labour (Sensitivity analyses: active management trials excluded), Outcome 2 Spontaneous vaginal delivery.
2.3
2.3. Analysis
Comparison 2 Early amniotomy and early oxytocin versus routine care on spontaneous labour (Sensitivity analyses: active management trials excluded), Outcome 3 Instrumental vaginal delivery (forceps or vacuum, or both).
2.4
2.4. Analysis
Comparison 2 Early amniotomy and early oxytocin versus routine care on spontaneous labour (Sensitivity analyses: active management trials excluded), Outcome 4 Length of first stage of labour.
2.5
2.5. Analysis
Comparison 2 Early amniotomy and early oxytocin versus routine care on spontaneous labour (Sensitivity analyses: active management trials excluded), Outcome 5 Duration of labour (duration in hours from admission in labour).
2.6
2.6. Analysis
Comparison 2 Early amniotomy and early oxytocin versus routine care on spontaneous labour (Sensitivity analyses: active management trials excluded), Outcome 6 Use of epidural analgesia.
2.7
2.7. Analysis
Comparison 2 Early amniotomy and early oxytocin versus routine care on spontaneous labour (Sensitivity analyses: active management trials excluded), Outcome 7 Postpartum haemorrhage (greater than 500 ml).
2.8
2.8. Analysis
Comparison 2 Early amniotomy and early oxytocin versus routine care on spontaneous labour (Sensitivity analyses: active management trials excluded), Outcome 8 Maternal blood transfusion.
2.9
2.9. Analysis
Comparison 2 Early amniotomy and early oxytocin versus routine care on spontaneous labour (Sensitivity analyses: active management trials excluded), Outcome 9 Postpartum fever or infection.
2.10
2.10. Analysis
Comparison 2 Early amniotomy and early oxytocin versus routine care on spontaneous labour (Sensitivity analyses: active management trials excluded), Outcome 10 Apgar score less than seven after five minutes.
2.11
2.11. Analysis
Comparison 2 Early amniotomy and early oxytocin versus routine care on spontaneous labour (Sensitivity analyses: active management trials excluded), Outcome 11 Acidosis as defined abnormal arterial cord pH (pH less than 7.10 or 7.20).
2.12
2.12. Analysis
Comparison 2 Early amniotomy and early oxytocin versus routine care on spontaneous labour (Sensitivity analyses: active management trials excluded), Outcome 12 Suboptimal or abnormal fetal heart.
2.13
2.13. Analysis
Comparison 2 Early amniotomy and early oxytocin versus routine care on spontaneous labour (Sensitivity analyses: active management trials excluded), Outcome 13 Fetal distress.
2.14
2.14. Analysis
Comparison 2 Early amniotomy and early oxytocin versus routine care on spontaneous labour (Sensitivity analyses: active management trials excluded), Outcome 14 Admission to special care nursery.
2.15
2.15. Analysis
Comparison 2 Early amniotomy and early oxytocin versus routine care on spontaneous labour (Sensitivity analyses: active management trials excluded), Outcome 15 Seizure/neurological abnormalities.
2.16
2.16. Analysis
Comparison 2 Early amniotomy and early oxytocin versus routine care on spontaneous labour (Sensitivity analyses: active management trials excluded), Outcome 16 Jaundice or hyperbilirubinemia.
2.17
2.17. Analysis
Comparison 2 Early amniotomy and early oxytocin versus routine care on spontaneous labour (Sensitivity analyses: active management trials excluded), Outcome 17 Satisfied with labour experience.
See this image and copyright information in PMC

Update of

References

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References to other published versions of this review

Wei 2009
    1. Wei S, Wo BL, Xu H, Luo ZC, Roy C, Fraser WD. Early amniotomy and early oxytocin for prevention of, or therapy for, delay in first stage spontaneous labour compared with routine care. Cochrane Database of Systematic Reviews 2009, Issue 2. [DOI: 10.1002/14651858.CD006794.pub2] - DOI - PubMed
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MeSH terms