title: Judicious use of oxytocin augmentation for the management of prolonged labor.
abstract: BACKGROUND
  A protocol including judicious use of oxytocin augmentation was investigated to determine whether it would change how oxytocin was used and eventually influence labor and fetal outcomes.
  
  
  METHODS
  The population of this cohort study comprised 20 227 delivering women with singleton pregnancies ≥37 weeks, cephalic presentation, spontaneous or induced onset of labor, without previous cesarean section. Women delivering from 2009 to 2013 at Stavanger University Hospital, Norway, were included. Data were collected prospectively. Before implementing the protocol in 2010, oxytocin augmentation was used if progression of labor was perceived as slow. After implementation, oxytocin could only be started when the cervical dilation had crossed the 4-h action line in the partograph.
  
  
  RESULTS
  The overall use of oxytocin augmentation was significantly reduced from 34.9% to 23.1% (p < 0.01). The overall frequency of emergency cesarean sections decreased from 6.9% to 5.3% (p < 0.05) and the frequency of emergency cesarean sections performed due to fetal distress was reduced from 3.2% to 2.0% (p = 0.01). The rate of women with duration of labor over 12 h increased from 4.4% to 8.5% (p < 0.01) and more women experienced severe estimated postpartum hemorrhage (2.6% vs. 3.7%; p = 0.01). The frequency of children with pH <7.1 in the umbilical artery was reduced from 4.7% to 3.2% (p < 0.01).
  
  
  CONCLUSIONS
  The frequency of emergency cesarean section was reduced after implementing judicious use of oxytocin augmentation. Our findings may be of interest in the ongoing discussion of how the balanced use of oxytocin for labor augmentation can best be achieved.
authors.affiliation: Department of Obstetrics and Gynecology, Sørlandet Hospital HF, Kristiansand, Norway.|Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Janne
authors.identifier: http://orcid.org/0000-0003-0983-4434
authors.initials: J
authors.lastname: Rossen
authors.affiliation: Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway.
authors.forename: Tilde B
authors.identifier: http://orcid.org/0000-0003-3600-0283
authors.initials: TB
authors.lastname: Østborg
authors.affiliation: Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway.
authors.forename: Elsa
authors.identifier: http://orcid.org/0000-0002-1368-9105
authors.initials: E
authors.lastname: Lindtjørn
authors.affiliation: Department of Clinical Science, University of Stavanger, Stavanger, Norway.
authors.forename: Jørn
authors.identifier: http://orcid.org/0000-0002-6240-4794
authors.initials: J
authors.lastname: Schulz
authors.affiliation: Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway.|National Center for Fetal Medicine, St. Olavs Hospital - Trondheim University Hospital, Trondheim, Norway.
authors.forename: Torbjørn M
authors.identifier: http://orcid.org/0000-0002-3162-9595
authors.initials: TM
authors.lastname: Eggebø
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000293:injuries; D002585:Cesarean Section / Q000706:statistics & numerical data* / Q000639:trends; D002985:Clinical Protocols; D004420:Dystocia / Q000188:drug therapy* / Q000601:surgery; D004630:Emergencies; D005260:Female; D005312:Fetal Blood / Q000737:chemistry; D005316:Fetal Distress / Q000601:surgery; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007231:Infant, Newborn; D007743:Labor, Obstetric; D022125:Lacerations / Q000453:epidemiology; D009664:Norway / Q000453:epidemiology; D010120:Oxytocics / Q000627:therapeutic use*; D010121:Oxytocin / Q000627:therapeutic use*; D006473:Postpartum Hemorrhage / Q000453:epidemiology; D011247:Pregnancy; D013997:Time Factors
chemical_list: D010120:Oxytocics; D010121:Oxytocin
keywords: Oxytocin augmentation; Ten group classification system; cesarean section; estimated postpartum hemorrhage; prolonged labor