Oxytocin Discontinuation at Active Labor Onset Investigated for Cesarean Delivery Rate Reduction

Oxytocin is a widely used synthetic hormone for inducing and augmenting labor, crucial for managing uterine contractions. However, its administration carries risks, including fetal heart rate (FHR) abnormalities and uterine hyperstimulation, which can lead to fetal distress and an increased likelihood of cesarean delivery. Current protocols often involve continuous or incremental oxytocin infusion throughout labor, but the optimal duration and timing of administration, particularly once active labor is established, remain subjects of debate and potential improvement to enhance maternal and neonatal outcomes. This study addresses the gap in evidence regarding the safety and efficacy of discontinuing oxytocin once active labor begins.

Investigators propose a prospective randomized controlled trial (RCT) comparing two oxytocin protocols for labor induction. One arm will follow an incremental oxytocin protocol until 5 cm dilation, then maintain the same level throughout labor. The experimental arm will also use an incremental oxytocin protocol, but discontinue oxytocin once the cervix reaches 5 cm dilation. The primary outcome will be the rate of cesarean delivery between the groups. Secondary outcomes include duration of labor, fetal heart rate abnormalities, frequency of uterine hyperstimulation, and other maternal and neonatal outcomes. The study aims to enroll pregnant women undergoing labor induction.

This research is a proposal for a randomized controlled trial, and therefore, no specific findings from this study are available yet. The investigators aim to determine if discontinuing oxytocin once active labor (defined as 5 cm dilation) begins can reduce the rate of cesarean delivery. Secondary outcomes, such as fetal heart rate abnormalities and uterine hyperstimulation, are also under investigation to assess safety and efficacy. A prior study from Israel, mentioned by the investigators, suggested no significant difference in pregnancy outcomes with a similar approach of discontinuing oxytocin in active labor. This proposed trial seeks to provide more robust evidence to confirm or refute such observations and establish a data-driven protocol.