Comparison between amniotomy, oxytocin or both for augmentation of labor in prolonged latent phase: a randomized controlled trial.
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.


CONCLUSIONS
Labor augmentation by combined amniotomy and oxytocin among women with a prolonged latent phase at term seems superior compared to either of them alone.
Rappaport Faculty of Medicine Technion, Israel Institute of Technology, Department of Obstetrics and Gynecology, Ha'Emek Medical Center, Afula, Israel.
Zohar
Z
Nachum
Gali
G
Garmi
Yfat
Y
Kadan
Noah
N
Zafran
Eliezer
E
Shalev
Raed
R
Salim
D000328:Adult; D000465:Algorithms; D000650:Amnion / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007751:Labor, Induced / Q000379:methods*; D007743:Labor, Obstetric / Q000187:drug effects / Q000502:physiology*; D010120:Oxytocics / Q000627:therapeutic use; D010121:Oxytocin / Q000627:therapeutic use*; D011247:Pregnancy; D013997:Time Factors; D055815:Young Adult
D010120:Oxytocics; D010121:Oxytocin