title: The timing of amniotomy, oxytocin and neuraxial analgesia and its association with labour duration and mode of birth.
abstract: OBJECTIVE
  The objective was to study the association of different timings of intrapartum interventions with labour duration and mode of birth.
  
  
  METHODS
  A longitudinal cohort study of 2,090 nulliparae and 1,873 multiparae with a singleton in cephalic presentation was conducted. We assessed the association between, on the one hand, the timing of augmentation with oxytocin, neuraxial analgesia and amniotomy, and, on the other hand, the time to complete dilatation, spontaneous or operative vaginal delivery or caesarean delivery, using a Cox regression model accounting for standard confounders.
  
  
  RESULTS
  From amniotomy onwards labour was accelerated. In multiparae, amniotomy was associated with an initial 6.6-fold acceleration, decreasing first stage duration until the hazard ratio reached around 3.5, where the intervention was performed 5 h after labour onset; thereafter, acceleration continued with a hazard ratio of around 3. In nulliparae, neuraxial analgesia was associated with a shorter first stage when administered between 7 and 11 h after labour onset; the later it was performed, the less likely was spontaneous birth and the more likely an operative vaginal birth in nulliparae or a caesarean section in multiparae. The start of oxytocin augmentation was associated with acceleration towards both full dilatation and caesarean section during first stage and an increased risk of operative vaginal birth during second stage. The later oxytocin augmentation started, the more likely it was that spontaneous birth would be retarded in multiparous women.
  
  
  CONCLUSIONS
  Applying amniotomy, oxytocin and neuraxial analgesia at their optimal timing may improve the progress and outcome of labour.
authors.affiliation: Midwifery Research and Education Unit, Department of Obstetrics, Gynaecology and Reproductive Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany, Gross.Mechthild@mh-hannover.de.
authors.forename: Mechthild M
authors.initials: MM
authors.lastname: Gross
authors.forename: Cornelia
authors.initials: C
authors.lastname: Frömke
authors.forename: Hartmut
authors.initials: H
authors.lastname: Hecker
mesh_terms: D000328:Adult; D000698:Analgesia; D015360:Analgesia, Epidural / Q000379:methods*; D002585:Cesarean Section; D015331:Cohort Studies; D036861:Delivery, Obstetric; D005321:Extraembryonic Membranes; D005260:Female; D006801:Humans; D007745:Labor Onset; D007751:Labor, Induced / Q000379:methods*; D007743:Labor, Obstetric; D008137:Longitudinal Studies; D010120:Oxytocics / Q000008:administration & dosage*; D010121:Oxytocin / Q000008:administration & dosage*; D059408:Pain Management / Q000379:methods; D036801:Parturition; D011247:Pregnancy; D016896:Treatment Outcome
chemical_list: D010120:Oxytocics; D010121:Oxytocin