Pulsatile versus continuous administration of oxytocin for induction and augmentation of labor: two randomized controlled trials.
OBJECTIVE
To determine whether pulsatile oxytocin infusion improves delivery outcome in women requiring induction or augmentation of labor.


METHODS
Two related randomized controlled trials undertaken in 2 inner-city United Kingdom university hospitals (ISRCTN72773405; http://www.isrctn.org/). Women were randomly assigned to a pulsatile or continuous infusion protocol.


METHODS
cesarean section rate (induction trial); operative delivery rate (augmentation trial).


RESULTS
For induction, cesarean section rates were similar in women receiving pulsatile (n = 264, 38.3%) vs continuous infusion of oxytocin (n = 257; 37.7%; risk ratio, 1.01; 95% confidence interval, 0.81-1.26; P = .903), but associated with increased "infusion to time of delivery" intervals (P < .001) in the pulsatile group. For augmentation, pulsatile infusion resulted in higher operative delivery rates (70.1%, n = 251) vs continuous infusion (62.7%, n = 249; risk ratio, 1.12; 95% confidence interval, 0.99-1.27; P = .077) and increased neonatal morbidity.


CONCLUSIONS
For induction, pulsatile infusion of oxytocin is effective, but conferred little clinical benefit. Pulsatile infusion is not recommended for augmentation.
Division of Women's Health, King's College London, Women's Health Academic Centre, King's Health Partners, St Thomas' Hospital Campus, London, England, UK. rachel.tribe@kcl.ac.uk
Rachel M
RM
Tribe
Sarah E
SE
Crawshaw
Paul
P
Seed
Andrew H
AH
Shennan
Philip N
PN
Baker
D000328:Adult; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous / Q000379:methods; D007751:Labor, Induced / Q000379:methods*; D010121:Oxytocin / Q000008:administration & dosage*; D011247:Pregnancy; D011256:Pregnancy Outcome; D055815:Young Adult
D010121:Oxytocin