title: Higher maximum doses of oxytocin are associated with an unacceptably high risk for uterine rupture in patients attempting vaginal birth after cesarean delivery.
abstract: OBJECTIVE
  The objective of the study was to more precisely estimate the effect of maximum oxytocin dose on uterine rupture risk in patients attempting vaginal birth after cesarean (VBAC) by considering timing and duration of therapy.
  
  
  METHODS
  A nested case-control study was conducted within a multicenter, retrospective cohort study of more than 25,000 women with at least 1 prior cesarean delivery, comparing cases of uterine rupture with controls (no rupture) while attempting VBAC. Time-to-event analyses were performed to examine the effect of maximum oxytocin dose on the risk of uterine rupture considering therapy duration, while adjusting for confounders.
  
  
  RESULTS
  Within the nested case-control study of 804 patients, 272 were exposed to oxytocin: 62 cases of uterine rupture and 210 controls. Maximum oxytocin ranges above 20 mU/min increased the risk of uterine rupture 4-fold or greater (21-30 mU/min: hazard ratio [HR] 3.92, 95% confidence interval [CI], 1.06 to 14.52; 31-40 mU/min: HR 4.57, 95% CI, 1.00 to 20.82).
  
  
  CONCLUSIONS
  These findings support a maximum oxytocin dose of 20 mU/min in VBAC trials to avoid an unacceptably high risk of uterine rupture.
authors.affiliation: Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO, USA.
authors.forename: Alison G
authors.initials: AG
authors.lastname: Cahill
authors.forename: Brian M
authors.initials: BM
authors.lastname: Waterman
authors.forename: David M
authors.initials: DM
authors.lastname: Stamilio
authors.forename: Anthony O
authors.initials: AO
authors.lastname: Odibo
authors.forename: Jenifer E
authors.initials: JE
authors.lastname: Allsworth
authors.forename: Bradley
authors.initials: B
authors.lastname: Evanoff
authors.forename: George A
authors.initials: GA
authors.lastname: Macones
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D010120:Oxytocics / Q000008:administration & dosage* / Q000009:adverse effects; D010121:Oxytocin / Q000008:administration & dosage* / Q000009:adverse effects; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014597:Uterine Rupture / Q000453:epidemiology / Q000209:etiology*; D016064:Vaginal Birth after Cesarean / Q000009:adverse effects*
chemical_list: D010120:Oxytocics; D010121:Oxytocin