Meta-Analysis of Low-Dose versus High-Dose Oxytocin for Labour Induction

Abstract

Many trials have attempted to determine the best dose of oxytocin for labour induction. This meta-analysis reviews and summarizes the results of all published English language randomized trials (and two unpublished trials) of low-dose versus high-dose oxytocin administration. The 11 trials identified underwent quality assessment, and data were abstracted from each study. Low-dose protocols resulted in fewer episodes of excessive uterine activity (summary odds ratio [OR] 0.41, 95 percent confidence interval [CI] 0.33–0.52), fewer operative vaginal deliveries (OR 0.58, 95 percent CI 0.40–0.83), a higher rate of spontaneous vaginal delivery (OR 1.67, 95 percent CI 1.27–2.20) and a trend toward a lower rate of Caesarean delivery (OR 0.78, 95 percent CI 0.60–1.02). There were lower rates of post-partum maternal infection (OR 0.57, 95 percent CI 0.32–0.99) and post-partum haemorrhage (OR 0.42, 95 percent CI 0.24–0.74) in the low-dose group. Although the ideal regimen is not known, induction of labour with the minimum dose of oxytocin to achieve active labour, increasing intervals no more frequently than every 30 minutes, is appropriate.