Induction of labor with oxytocin increases cesarean section rate as compared with oxytocin for augmentation of spontaneous labor in nulliparous parturients controlled for lumbar epidural analgesia

Nov 30, 2004Journal of clinical anesthesia

Using oxytocin to start labor increases cesarean rates compared to using it to speed up natural labor in first-time mothers with epidural pain relief

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Abstract

Of the 1671 healthy nulliparous women analyzed, 675 received oxytocin for elective induction of labor.

Women undergoing induced labor requested epidural analgesia significantly sooner than those with augmented spontaneous labor.
The incidence of cesarean sections was notably higher in the group induced with oxytocin compared to the augmentation group.
Labor outcomes, including timing for epidural request and delivery methods, may differ between induced and augmented labor.

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STUDY OBJECTIVES: To study labor outcomes in parturients receiving oxytocin for augmentation or induction of labor, in the presence of labor epidural analgesia.

DESIGN: Retrospective study of data from a continuous quality improvement database.

SETTING: Tertiary-care hospital with more than 8000 deliveries per annum.

MEASUREMENTS AND MAIN RESULTS: Of the 1671 healthy nulliparous women with singleton pregnancies and who requested labor epidural analgesia at our institution, 675 patients received oxytocin during elective induction of labor, whereas 996 patients received oxytocin for augmentation of spontaneous labor. Measured variables were cervical dilatation at time of epidural analgesia request, epidural insertion to 10-cm time, duration of stage 2 of labor, normal spontaneous vaginal delivery rate, cesarean section rate, operative vaginal delivery rate, and baby weight. Women admitted for induction of labor requested epidural analgesia sooner than those who had their labor augmented (p < 0.001). The incidence of cesarean section was higher in the induced group (p = 0.008).

CONCLUSION: Patients who have their labor induced request analgesia sooner and are at a higher risk of cesarean section than are patients who go into labor spontaneously. Any study that purports to assess the effects of epidural analgesia in labor should distinguish between induced and augmented/spontaneous labor.

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Induction of labor with oxytocin increases cesarean section rate as compared with oxytocin for augmentation of spontaneous labor in nulliparous parturients controlled for lumbar epidural analgesia

Abstract

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