Abstract
BackgroundOxytocin is an effective drug for induction of labour, but is associated with serious adverse effects of which uterine tachysystole, fetal distress and the need of immediate delivery are the most common. Discontinuation of oxytocin once the active phase of labour is established could reduce the adverse effects.The objective is to investigate how the caesarean section rate is affected when oxytocin stimulation is discontinued in the active phase of labour compared to labours where oxytocin is continued.MethodsCONDISOX is a double-blind multicentre randomised controlled trial conducted at Danish and Dutch Departments of Obstetrics and Gynaecology. The first participant was recruited on April 8 2016.Based on a clinically relevant relative reduction in caesarean section rate of 7%, an alpha of 0.05, a beta of 80%, we aim for 1200 participating women (600 in each arm).The CONDISOX trial includes women at a gestational age of 37–42 complete weeks of pregnancy, who have uterine activity stimulated with oxytocin infusion for the induction of labour. Women are randomised when the active phase of labour becomes established, to study medication containing either oxytocin (continuous group) or placebo (discontinued group) infusion. Women are stratified by birth site, indication for oxytocin stimulation (induction of labour, prelabour rupture of membranes) and parity (nulliparous, parous +/− previous caesarean section).We will compare the primary outcome, caesarean section rate, in the two groups using a chi-square test with a p-value of 0.05. If superiority is not demonstrated, we have a pre-defined post hoc non-inferiority boundary (margin, delta) at 1.09.Secondary outcomes include duration of the active phase of labour, incidence of uterine tachysystole, postpartum haemorrhage, admission to the neonatal intensive care unit, Apgar score, umbilical arterial blood pH, and birth experience.DiscussionThe high frequency of oxytocin use and the potential risks of both maternal and fetal adverse effects of oxytocin emphasise the need to determine the optimal oxytocin regime for induction of labour.Trial registrationNCT02553226 (registered September 17, 2015). Eudra-CT number: 2015–002942-30.
Highlights
Oxytocin is an effective drug for induction of labour, but is associated with serious adverse effects of which uterine tachysystole, fetal distress and the need of immediate delivery are the most common
Despite the extensive use of oxytocin only a few studies have focused on the duration of the infusion
There is no consensus as to whether oxytocin should be continued until delivery or discontinued after the onset of the active phase of labour [1,2,3,4]
Summary
Oxytocin is an effective drug for induction of labour, but is associated with serious adverse effects of which uterine tachysystole, fetal distress and the need of immediate delivery are the most common. Discontinuation of oxytocin once the active phase of labour is established could reduce the adverse effects. In Denmark 2018, 27% nulliparous (8065 of 29, 414) and 21% parous women (6636 of 31,502) had labour induced Half of these women received oxytocin stimulation as a single treatment method, or in combination with other methods There is no consensus as to whether oxytocin should be continued until delivery or discontinued after the onset of the active phase of labour [1,2,3,4]. The current regimen for induction of labour with oxytocin described in the national Danish Society of Obstetrics and Gynaecology (DSOG) guidelines [5] recommends that the infusion continues until delivery, unless complications (e.g. uterine tachysystole) occur, at which point the infusion rate is reduced or discontinued
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