High vs. Low Dose Oxytocin RCT Compares Caesarean Rates in Delayed Labor Augmentation

Approximately 15-20% of deliveries involve delayed labor progress, a common obstetric challenge, particularly in nulliparous women, increasing the risk of adverse outcomes including caesarean delivery. Oxytocin is widely used for labor augmentation, stimulating uterine contractions to improve progression. However, despite its widespread application, there is a notable lack of robust, evidence-based guidelines regarding optimal dosing regimens for oxytocin. Existing studies on the efficacy and safety of oxytocin for slow labor progression often present conflicting results, leading to variations in clinical practice. This gap in knowledge underscores the critical need for well-designed studies to establish clear protocols that balance effective labor progression with maternal and neonatal safety.

This randomized controlled trial (RCT) was conducted across six study centers/labour wards in Sweden, enrolling 2072 consenting nulliparous women experiencing active phase of labor with defined delayed labor progress. Participants were randomized to receive either a high dose oxytocin regimen or a low dose oxytocin regimen for augmentation. The primary outcome measured was the caesarean delivery rate. Secondary outcomes included Apgar score, need for neonatal intensive care, incidence of hyper-stimulation of contractions, spontaneous vaginal birth rate, length of labour, postpartum haemorrhage, sphincter lacerations, experienced labour pain, epidural analgesia use, and women's childbirth experience one month postpartum, assessed via the Childbirth Experience Questionnaire.