title: Early amniotomy and early oxytocin for prevention of, or therapy for, delay in first stage spontaneous labour compared with routine care.
abstract: BACKGROUND
  Caesarean section rates are over 20% in many developed countries. The main diagnosis contributing to the high rate in nulliparae is dystocia or prolonged labour. The present review assesses the effects of a policy of early amniotomy with early oxytocin administration for the prevention of, or the therapy for, delay in labour progress.
  
  
  OBJECTIVE
  To estimate the effects of early augmentation with amniotomy and oxytocin for prevention of, or therapy for, delay in labour progress on the caesarean birth rate and on indicators of maternal and neonatal morbidity.
  
  
  METHODS
  We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (15 February 2012), MEDLINE (1966 to 15 February 2012), EMBASE (1980 to 15 February 2012), CINAHL (1982 to 15 February 2012), MIDIRS (1985 to February 2012) and contacted authors for data from unpublished trials.
  
  
  METHODS
  Randomized and quasi-randomized controlled trials that compared oxytocin and amniotomy with expectant management.
  
  
  METHODS
  Three review authors extracted data independently. We stratified the analyses into 'Prevention Trials' and 'Therapy Trials' according to the status of the woman at the time of randomization. Participants in the 'Prevention Trials' were unselected women, without slow progress in labour, who were randomized to a policy of early augmentation or to routine care. In 'Treatment Trials' women were eligible if they had an established delay in labour progress.
  
  
  RESULTS
  For this update, we have included a further two new clinical trials. This updated review includes 14 trials, randomizing a total of 8033 women. The unstratified analysis found early intervention with amniotomy and oxytocin to be associated with a modest reduction in the risk of caesarean section; however, the confidence interval (CI) included the null effect (risk ratio (RR) 0.89; 95% CI 0.79 to 1.01; 14 trials; 8033 women). In prevention trials, early augmentation was associated with a modest reduction in the number of caesarean births (RR 0.87; 95% CI 0.77 to 0.99; 11 trials; 7753). A policy of early amniotomy and early oxytocin was associated with a shortened duration of labour (average mean difference (MD) - 1.28 hours; 95% CI -1.97 to -0.59; eight trials; 4816 women). Sensitivity analyses excluding four trials with a full package of active management did not substantially affect the point estimate for risk of caesarean section (RR 0.87; 95% CI 0.73 to 1.05; 10 trials; 5165 women). We found no other significant effects for the other indicators of maternal or neonatal morbidity.
  
  
  CONCLUSIONS
  In prevention trials, early intervention with amniotomy and oxytocin appears to be associated with a modest reduction in the rate of caesarean section over standard care.
authors.affiliation: Département d'Obstétrique-Gynécologie, Université de Montréal, Hôpital, Canada.
authors.forename: Shuqin
authors.initials: S
authors.lastname: Wei
authors.forename: Bi Lan
authors.initials: BL
authors.lastname: Wo
authors.forename: Hui-Ping
authors.initials: HP
authors.lastname: Qi
authors.forename: Hairong
authors.initials: H
authors.lastname: Xu
authors.forename: Zhong-Cheng
authors.initials: ZC
authors.lastname: Luo
authors.forename: Chantal
authors.initials: C
authors.lastname: Roy
authors.forename: William D
authors.initials: WD
authors.lastname: Fraser
mesh_terms: D000650:Amnion / Q000601:surgery*; D002585:Cesarean Section / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007747:Labor Stage, First; D007744:Obstetric Labor Complications / Q000517:prevention & control / Q000628:therapy*; D010120:Oxytocics / Q000008:administration & dosage*; D010121:Oxytocin / Q000008:administration & dosage*; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors
chemical_list: D010120:Oxytocics; D010121:Oxytocin