Comparison between amniotomy, oxytocin or both for augmentation of labor in prolonged latent phase: a randomized control
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RESEARCH
Open Access
Comparison between amniotomy, oxytocin or both for augmentation of labor in prolonged latent phase: a randomized controlled trial Zohar Nachum, Gali Garmi, Yfat Kadan, Noah Zafran, Eliezer Shalev*, Raed Salim
Abstract Background: A prolonged latent phase is independently associated with an increased incidence of subsequent labor abnormalities. We aimed to compare between oxytocin augmentation, amniotomy and a combination of both on the duration of labor among women with a prolonged latent phase. Methods: Women with a singleton fetus in cephalic presentation who have a prolonged latent phase, were randomly allocated to amniotomy (group 1), oxytocin (group 2) or both (group 3). A group of women who progressed spontaneously without intervention composed the control group (group 4). The primary outcome was the duration of time from initiation of augmentation until delivery. Results: A total of 213 women were consented and randomized to group 1 (70 women), group 2 (72 women) and group 3 (71 women). Group 4 was composed from additional 70 women. A mean reduction of 120 minutes in labor duration was observed among group 3 compared to group 1 (p = 0.08) and 180 minutes compared to group 2 and 4 (p = 0.001). Women in group 3 had a shorter length of time from augmentation until the beginning of the active phase and a shorter first stage of labor than group 1 (p = 0.03), group 2 (p = 0.001) and group 4 (p = 0.001). Satisfaction was greater among group 3 and 4. Mode of delivery and neonatal outcome were comparable between the groups. Conclusion: Labor augmentation by combined amniotomy and oxytocin among women with a prolonged latent phase at term seems superior compared to either of them alone.
Background Arrested or prolonged labor is a frequent indication for cesarean delivery [1,2]. Prolonged labor is also associated with increased pain and negative birth experiences [3,4]. Furthermore, women with a longer first stage of labor have experienced a higher rate of postpartum hemorrhage, chorioamnionitis and neonatal admission to the intensive care unit [5]. A prolonged latent phase is independently associated with an increased incidence of subsequent labor abnormalities, an increased rate of cesarean delivery, thick meconium, depressed Apgar scores, and the need for newborn resuscitation [6,7].
* Correspondence: [email protected] Rappaport Faculty of Medicine Technion, Israel Institute of Technology, Department of Obstetrics and Gynecology, Ha’Emek Medical Center, Afula, Israel
The incidence of a prolonged latent phase has been reported to be three to four percent regardless of parity [8]. Although the optimal management is uncertain, augmentation of labor has been proposed as an adequate approach to the problem of prolonged latent phase, as well as a strategy to reduce the rate of cesarean delivery [7]. This intervention is based on the hypothesis that the most frequent cause of dystocia is inadequate uterine contraction. Oxytocin augmentation of uterine contractions with or without amniotomy i
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