Currently used oxytocin regimen outcome measures at term & postterm. I: Outcome indicators in relation to parity & indication for induction.

Mar 12, 2008Ethiopian medical journal

Outcomes of Oxytocin Use at Full Term and After: How Results Vary by Number of Births and Reason for Induction

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Abstract

Five hundred fifty-two women were induced at term and post term with an overall elective to emergency induction ratio of about 1:1.

The most common indications for induction included post term, term premature rupture of fetal membranes, and hypertension.
Spontaneous vertex delivery occurred in 46.4% of cases, while 28.4% resulted in caesarean section for failed induction.
Both nulliparas and multiparas had similar rates of establishing labor, at 84.1% and 84.8% respectively.
The mean oxytocin level required for adequate uterine contractions was 33.6 mu/min for nulliparas and 17.2 mu/min for multiparas.
The average time from initiation of induction to achieving adequate uterine contractions was approximately 2 hours and 10 minutes for both groups.
More than two-thirds of multiparous and half of nulliparous women achieved adequate contractions with oxytocin infusion rates of 20 mu/min or less.

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INTRODUCTION: Although induction of labour with oxytocin is a daily practice at public as well as private health institutions, to the best of our knowledge, there is no published study on induction in Ethiopia.

OBJECTIVE: To assess the oxytocin dose required to achieve adequate uterine contraction, the time interval between initiation of oxytocin and adequate contraction achieved and the time lapsed between initiation of induction and vaginal delivery.

METHODOLOGY: A two-year retrospective case-series study was done to evaluate the currently used oxytocin regimen outcome measures at Gandhi and St. Paul's hospitals. Oxytocin level in milliunit/minute to achieve adequate uterine contraction, time lapsed to establish labour and deliver vaginally, Bishop Score, and indications for induction were some of the variables included.

RESULTS: Five hundred fifty two women induced at term and post term (55.8% nulliparas and 44.2% multiparas) were reviewed with overall elective to emergency induction ratio about 1:1. The first three indications for induction were post term (P < 0.05), term premature rupture of fetal membranes and hypertension (P = 0.005). Spontaneous vertex delivery (46.4%), caesarean section for failed induction (28.4%) and fetal distress (9.6%) were the top modes of delivery in both nulliparas and multiparas. Equal proportion of nulliparas and multiparas established labour (84.1% vs 84.8%) with mean oxytocin level in mu/min 33.6 +/- 21.9 and 17.2 +/- 11.4 and mean time lapsed in hours 2:10 +/- 1:30 and 2:10 +/- 1:10 between initiation of induction and adequate uterine contraction, respectively. More than two-thirds of multiparous and half of nulliparous women achieved adequate uterine contractions with 20-mu/min and less oxytocin infusion among the total women (84.4%) who were diagnosed to have adequate uterine contractions.

CONCLUSION: Although the starting, increment and maximum oxytocin regimen for nulliparas and multiparas were different but with parallel Bishop Score, the induction initiation to vaginal delivery time was almost comparable. Very high oxytocin dose for nulliparas wasn't superior to multiparas dose.

Currently used oxytocin regimen outcome measures at term & postterm. I: Outcome indicators in relation to parity & indication for induction.

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