Early Versus Delayed Oxytocin Infusion Following Amniotomy in Nulliparous Women

NCT ID: NCT04200599

Last Updated: 2019-12-16

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

250 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-08-01

Study Completion Date

2016-03-31

Brief Summary

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In UKM Medical Centre (UKMMC), delayed oxytocin augmentation at two hours following amniotomy is the routine obstetric practice in spontaneous or induced labour with intact membranes. This practice may potentially cause prolonged labour, extended labour room occupancy and increased maternal exhaustion while no additional benefit can be gained. On the other hand, recommendation for early oxytocin augmentation poses a dilemma as the effectiveness and safety of this practice are still in doubt.

Given this background, the aim of this study was to compare the effect of early versus delay oxytocin infusion in achieving successful vaginal delivery among the low-risk nulliparous women in UKMMC. Besides, this study also compares the adverse maternal and neonatal outcomes between the two practices.

Detailed Description

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This was a randomised controlled trial undertaken in the labour room of UKMMC for a period of eighteen months from August 2014 until February 2016. Eligible women who were admitted in spontaneous labour or for induction of labour were recruited. For women who underwent induction of labour, an interval of at least six hours following vaginal prostaglandin before recruitment was mandatory to avoid overlapping effect of prostaglandin and oxytocin. Upon enrolment, each patient was given a study explanation and written consent was obtained.

The randomisation sequence, either to the early oxytocin group or the delayed oxytocin group, was generated using the computer randomisation program in block of two. Allocation to either arm of treatment was determined by the sequential opening of sealed numbered envelopes.

In the first arm of early oxytocin group, labour augmentation with oxytocin was started early following artificial ruptured of membrane(ARM). In the second arm of delayed oxytocin group, oxytocin augmentation was delayed at two hours after ARM and this practice is currently being used as standard protocol in this hospital to manage women in labour. In both arms,the infusion rate was doubled every 30 minutes to a maximum of 48 mL/h or until four to five moderate contractions per 10 minutes were achieved at which point the infusion rate was maintained. Continuous fetal heart rate monitoring was maintained throughout the intrapartum period. Vaginal examination was performed at four hours after ARM as well as when clinically indicated ie. abnormal cardiotocography (CTG) and maternal desire to bear down. In the presence of abnormal CTG, either fetal blood sampling or expedited delivery was undertaken as per decided by the obstetrician in charge.

Conditions

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Delivery Delayed Mode of Delivery Post Partum Hemorrhage Uterine Hyperstimulation

Keywords

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primigravida amniotomy, immediate oxytocin delayed oxytocin

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants

Study Groups

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Early oxytocin Infusion

labour augmentation with oxytocin was started early following amniotomy.

Group Type EXPERIMENTAL

duration of initiation of oxytocin

Intervention Type OTHER

mode of delivery

Late oxytocin infusion

oxytocin augmentation was delayed at two hours after amniotomny and this practice is currently being used as standard protocol in this hospital to manage women in labour.

Group Type ACTIVE_COMPARATOR

duration of initiation of oxytocin

Intervention Type OTHER

mode of delivery

Interventions

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duration of initiation of oxytocin

mode of delivery

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* gestational age between 36+0 to 41+6 weeks
* singleton pregnancies in cephalic presentation
* estimated fetal weight between 2.5 - 4.0 kg
* cervical dilatation of 4 cm with intact membranes
* normal fetal heart rate trace before artificial rupture of membranes

Exclusion Criteria

* Women with significant medical (eg. heart disease, pre-eclampsia, diabetes with high dose insulin, retroviral disease)
* fetal abnormality (eg. fetal growth restriction or small for gestational age \< 2.5 kg, suspected macrosomia \> 4.0 kg, fetal anomaly)
Minimum Eligible Age

19 Years

Maximum Eligible Age

45 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

Yes

Sponsors

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National University of Malaysia

OTHER

Sponsor Role lead

Responsible Party

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Azrai Abu

Clinical Consultant

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Muhammad azrai abu

Role: PRINCIPAL_INVESTIGATOR

Department of Obstetrics and Gynecology, UKM Medical Centre

References

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Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, Wagner M. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007 Mar;21(2):98-113. doi: 10.1111/j.1365-3016.2007.00786.x.

Reference Type RESULT
PMID: 17302638 (View on PubMed)

Barber EL, Lundsberg LS, Belanger K, Pettker CM, Funai EF, Illuzzi JL. Indications contributing to the increasing cesarean delivery rate. Obstet Gynecol. 2011 Jul;118(1):29-38. doi: 10.1097/AOG.0b013e31821e5f65.

Reference Type RESULT
PMID: 21646928 (View on PubMed)

O'Driscoll K, Jackson RJ, Gallagher JT. Prevention of prolonged labour. Br Med J. 1969 May 24;2(5655):477-80. doi: 10.1136/bmj.2.5655.477.

Reference Type RESULT
PMID: 5771578 (View on PubMed)

Dencker A, Berg M, Bergqvist L, Ladfors L, Thorsen LS, Lilja H. Early versus delayed oxytocin augmentation in nulliparous women with prolonged labour--a randomised controlled trial. BJOG. 2009 Mar;116(4):530-6. doi: 10.1111/j.1471-0528.2008.01962.x.

Reference Type RESULT
PMID: 19250364 (View on PubMed)

Hinshaw K, Simpson S, Cummings S, Hildreth A, Thornton J. A randomised controlled trial of early versus delayed oxytocin augmentation to treat primary dysfunctional labour in nulliparous women. BJOG. 2008 Sep;115(10):1289-95; discussion 1295-6. doi: 10.1111/j.1471-0528.2008.01819.x.

Reference Type RESULT
PMID: 18715415 (View on PubMed)

Selo-Ojeme DO, Pisal P, Lawal O, Rogers C, Shah A, Sinha S. A randomised controlled trial of amniotomy and immediate oxytocin infusion versus amniotomy and delayed oxytocin infusion for induction of labour at term. Arch Gynecol Obstet. 2009 Jun;279(6):813-20. doi: 10.1007/s00404-008-0818-x. Epub 2008 Oct 29.

Reference Type RESULT
PMID: 18958483 (View on PubMed)

Wei SQ, Luo ZC, Xu H, Fraser WD. The effect of early oxytocin augmentation in labor: a meta-analysis. Obstet Gynecol. 2009 Sep;114(3):641-649. doi: 10.1097/AOG.0b013e3181b11cb8.

Reference Type RESULT
PMID: 19701046 (View on PubMed)

Bugg GJ, Siddiqui F, Thornton JG. Oxytocin versus no treatment or delayed treatment for slow progress in the first stage of spontaneous labour. Cochrane Database Syst Rev. 2013 Jun 23;2013(6):CD007123. doi: 10.1002/14651858.CD007123.pub3.

Reference Type RESULT
PMID: 23794255 (View on PubMed)

Tan PC, Soe MZ, Sulaiman S, Omar SZ. Immediate compared with delayed oxytocin after amniotomy labor induction in parous women: a randomized controlled trial. Obstet Gynecol. 2013 Feb;121(2 Pt 1):253-259. doi: 10.1097/AOG.0b013e31827e7fd9.

Reference Type RESULT
PMID: 23344273 (View on PubMed)

Delgado Nunes V, Gholitabar M, Sims JM, Bewley S; Guideline Development Group. Intrapartum care of healthy women and their babies: summary of updated NICE guidance. BMJ. 2014 Dec 3;349:g6886. doi: 10.1136/bmj.g6886. No abstract available.

Reference Type RESULT
PMID: 25472418 (View on PubMed)

Liston R, Sawchuck D, Young D. No. 197a-Fetal Health Surveillance: Antepartum Consensus Guideline. J Obstet Gynaecol Can. 2018 Apr;40(4):e251-e271. doi: 10.1016/j.jogc.2018.02.007.

Reference Type RESULT
PMID: 29680082 (View on PubMed)

Other Identifiers

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PPI/111/8/JEP-2015-022

Identifier Type: -

Identifier Source: org_study_id