The outcome of prolonged labor as defined by partography and the use of oxytocin: a descriptive study.
A descriptive study of 300 consecutive spontaneous labors in primigravid patients whose pregnancies were of 37 or more weeks' gestation with a singleton fetus in the vertex presentation, showed a cesarean section rate of 13%, a forceps delivery rate of 49%, and a spontaneous delivery rate of 38%. Oxytocin was used in 17% and epidural analgesia was used in 75% of the patients. The median rate for cervical dilatation for those women with spontaneous deliveries was 2 cm/hr (interquartile range = 1.5 to 3.3 cm/hr) and for those delivered with forceps, 1.2 cm/hr (interquartile range = 0.9 to 1.8 cm/hr). When labor was prolonged by 4 hours or more, the cesarean section rate rose to 34%. Oxytocin was used in only 41% of these patients. Of 23 women delivered by cesarean section for dystocia/disproportion, only nine received oxytocin. From the low incidence of low Apgar scores in all labor groups from this series, there would not appear to be a fetal advantage to earlier intervention. Although the suggestion from this study is that oxytocin administration when labor is prolonged by 4 hours will reduce the need for cesarean section, the true value of such an intervention can be tested only by a randomized controlled trial.
D000293:Adolescent; D000328:Adult; D000767:Anesthesia, Epidural; D000773:Anesthesia, Obstetrical; D001034:Apgar Score; D002585:Cesarean Section; D036861:Delivery, Obstetric; D004420:Dystocia / Q000188:drug therapy; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007743:Labor, Obstetric / Q000187:drug effects*; D009772:Obstetrical Forceps; D010121:Oxytocin / Q000494:pharmacology* / Q000627:therapeutic use; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D013997:Time Factors
D010121:Oxytocin