Effect of intra-partum Oxytocin on neonatal encephalopathy: a systematic review and meta-analysis

Constance Burgod,Paolo Montaldo,Phoebe Ivain,Ramyia Elangovan,Stuti Pant,Maria Moreno Morales,Sudhin Thayyil,Paul Bassett

doi:10.1186/s12884-021-04216-3

Abstract

BackgroundOxytocin is widely used for induction and augmentation of labour, particularly in low- and middle-income countries (LMICs). In this systematic review and meta-analysis, we examined the effect of intra-partum Oxytocin use on neonatal encephalopathy.MethodsThe protocol for this study was registered with PROSPERO (ID: CRD42020165049). We searched Medline, Embase and Web of Science Core Collection databases for papers published between January 1970 and May 2021. We considered all studies involving term and near-term (≥36 weeks’ gestation) primigravidae and multiparous women. We included all randomised, quasi-randomised clinical trials, retrospective studies and non-randomised prospective studies reporting intra-partum Oxytocin administration for induction and/or augmentation of labour. Our primary outcome was neonatal encephalopathy. Risk of bias was assessed in non-randomised studies using the Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I) tool. The RoB 2.0 tool was used for randomised studies. A Mantel-Haenszel statistical method and random effects analysis model were used for meta-analysis. Odds ratios were used to determine effect measure and reported with 95% confidence intervals.ResultsWe included data from seven studies (6 Case-control studies, 1 cluster-randomised trial) of which 3 took place in high-income countries (HICs) and 4 in LMICs. The pooled data included a total of 24,208 women giving birth at or after 36 weeks; 7642 had intra-partum Oxytocin for induction and/or augmentation of labour, and 16,566 did not receive intra-partum Oxytocin. Oxytocin use was associated with an increased prevalence of neonatal encephalopathy (Odds Ratio 2.19, 95% CI 1.58 to 3.04; p < 0.00001).ConclusionsIntra-partum Oxytocin may increase the risk of neonatal encephalopathy. Future clinical trials of uterotonics should include neonatal encephalopathy as a key outcome.

Highlights

Oxytocin is widely used for induction and augmentation of labour, in low- and middleincome countries (LMICs)
Intra-partum Oxytocin administration has been shown to reduce the mean duration in labour in several clinical trials [5]
A Cochrane review comparing high doses and low doses of Oxytocin [7] reported no significant difference in caesarean section rates, vaginal delivery not achieved within 24 h or neonatal morbidity/perinatal death

Summary

Introduction

Oxytocin is widely used for induction and augmentation of labour, in low- and middleincome countries (LMICs). Intra-partum Oxytocin administration has been shown to reduce the mean duration in labour in several clinical trials [5]. This is a major benefit as a prolonged labour is often correlated with a higher risk of post-partum haemorrhage and maternal death, in LMICs [6]. Rates of caesarean section and instrumental deliveries were not significantly different in women administered with Oxytocin compared to no treatment [5]. A Cochrane review comparing high doses and low doses of Oxytocin [7] reported no significant difference in caesarean section rates, vaginal delivery not achieved within 24 h or neonatal morbidity/perinatal death (such as seizures, birth asphyxia, neonatal encephalopathy and disability in childhood)

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Results

Conclusion