Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Department of Neonatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
PLoS One. 2022 Apr 22;17(4):e0267400. doi: 10.1371/journal.pone.0267400. eCollection 2022.
A variety of oxytocin regimens are used for labor induction and augmentation. Considering the increasing rates of labor induction, it is important to assess the most optimal oxytocin regimen without compromising maternal and fetal safety. The aim of this study was to compare delivery outcomes of low-dose and high-dose oxytocin induction protocols. This retrospective cohort study of 487 women comparing low-dose oxytocin protocol (n = 280) and high-dose oxytocin protocol (n = 207) in labor induction following cervical ripening by balloon catheter was performed in Helsinki University Hospital after implementation of a new oxytocin induction protocol. The study included two six-month cohorts from 2016 and 2019. Women with vital singleton pregnancies ≥37 gestational weeks, cephalic presentation, and intact amniotic membranes were included. The primary outcome was the rate of vaginal delivery. The secondary outcomes were the rates of maternal and neonatal infections, postpartum hemorrhage, umbilical artery blood pH-value, admission to neonatal intensive care, and induction-to-delivery interval. Statistical analyses were performed by using IBM SPSS Statistics for Windows (Armonk, NY, USA). The rate of vaginal delivery was higher [69.9% (n = 144) vs. 47.9% (n = 134); p<0.004] and the rates of maternal and neonatal infection were lower during the new high-dose oxytocin protocol [maternal infections 13.6% (n = 28) vs. 22.1% (n = 62); p = 0.02 and neonatal infection 2.9% (n = 6) vs. 14.6% (n = 41); p<0.001, respectively]. The rates of post-partum hemorrhage, umbilical artery blood pH-value <7.05 or neonatal intensive care admissions did not differ between the cohorts. The median induction-to-delivery interval was shorter in the new protocol [32.0 h (IQR 18.5-42.7) vs. 37.9 h (IQR 27.8-52.8); p<0.001]. In conclusion, implementation of the new continuous high-dose oxytocin protocol resulted in higher rate of vaginal delivery and lower rate of maternal and neonatal infections. Our experience supports the use of high-dose continuous oxytocin induction regimen with a practice of stopping oxytocin once active labor is achieved, and a 15-18-hour maximum duration for oxytocin induction in the latent phase of labor following cervical ripening with a balloon catheter.
各种催产素方案用于引产和催产。考虑到引产率的不断增加，评估最理想的催产素方案而不影响母婴安全非常重要。本研究旨在比较低剂量和高剂量催产素诱导方案的分娩结局。
这项回顾性队列研究纳入了在赫尔辛基大学医院实施新的催产素诱导方案后，通过球囊导管宫颈成熟后进行引产的 487 名妇女，比较了低剂量催产素方案（n=280）和高剂量催产素方案（n=207）。该研究包括 2016 年和 2019 年的两个 6 个月队列。纳入有活力的单胎妊娠≥37 孕周、头位和完整胎膜的妇女。主要结局是阴道分娩率。次要结局是母婴感染、产后出血、脐动脉血 pH 值、新生儿重症监护病房入院和引产至分娩的间隔。统计分析采用 IBM SPSS Statistics for Windows（Armonk，NY，USA）进行。新的高剂量催产素方案的阴道分娩率更高[69.9%（n=144）vs.47.9%（n=134）；p<0.004]，母婴感染率更低[母亲感染 13.6%（n=28）vs.22.1%（n=62）；p=0.02 和新生儿感染 2.9%（n=6）vs.14.6%（n=41）；p<0.001]。两组之间产后出血、脐动脉血 pH 值<7.05 或新生儿重症监护病房入院率无差异。新方案的中位引产至分娩间隔更短[32.0 h（IQR 18.5-42.7）vs.37.9 h（IQR 27.8-52.8）；p<0.001]。
总之，实施新的连续高剂量催产素方案可提高阴道分娩率，降低母婴感染率。我们的经验支持使用高剂量连续催产素诱导方案，一旦出现活跃的分娩就停止催产素，并在宫颈成熟后通过球囊导管进行潜伏期引产时，将催产素诱导的最长时间限制在 15-18 小时。
