Download PDF
Am J Perinatol 2024; 41(S 01): e739-e746
DOI: 10.1055/a-1933-7340
Original Article

Outcome of Inducing Labor in Pregnancies with Suspected Fetal Growth Restriction: Oxytocin Discontinuation during the Active Phase of Labor versus Conventional Management

Sayuri Iwai
1   Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
,
Kazuya Mimura 
1   Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
,
Masayuki Endo
1   Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
,
Yoko Kawanishi
1   Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
,
Tatsuya Miyake
1   Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
,
Kosuke Hiramatsu
1   Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
,
Toshihiro Kimura
1   Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
,
Takuji Tomimatsu
1   Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
,
Tadashi Kimura
1   Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
› Author Affiliations Funding This study was supported by a Grant-in-Aid for Scientific Research (grant numbers: 20K09618 and 21K09447) from the Ministry of Education, Culture, Sports, Science, and Technology of Japan and from the Japan Society for the Promotion of Science.
› Further Information
    Permissions and Reprints

Abstract

Objective Although fetal growth restriction (FGR) is associated with an increased risk of cesarean delivery during induced labor, there is limited evidence to guide labor management. This study aimed to investigate the prognosis of induced labor in pregnancies with suspected FGR and whether oxytocin discontinuation during the active phase of labor affects maternal and neonatal outcomes.

Study Design This retrospective cohort study investigated singleton pregnancies with vertex presentation and indications for labor induction owing to FGR after 34.0 weeks of gestation at Osaka University Hospital. From January 2010 to December 2013, women were conventionally managed, and oxytocin was continued until delivery unless there was an indication for discontinuation (conventional management group). From January 2013 to December 2020, oxytocin was routinely discontinued, or the dose was reduced at the beginning of the active phase of labor (oxytocin discontinuation group).

Results A total of 161 women (conventional management group, n = 74; oxytocin discontinuation group, n = 87) were included. After the active phase of induced labor, the total incidence of cesarean delivery was very low (3.1%), and the duration was short (173 ± 145 minutes). Oxytocin discontinuation was associated with lower cesarean delivery (1.1 vs. 5.4%; p = 0.12) and uterine tachysystole (9.8 vs. 23.0%; p = 0.08) rates and longer duration of the second stage of labor (mean: 56.5 ± 90 vs. 34.2 ± 45 minutes; p = 0.08) than conventional management; however, the difference was not significant. The other maternal and neonatal outcomes, including postpartum hemorrhage, did not also significantly differ between them.

Conclusion After the active phase of induced labor for suspected FGR, the risk of cesarean delivery is low, and the high incidence of uterine tachysystole and rapid labor progression should be considered cautiously. Oxytocin can be safely discontinued during the active phase of labor in women undergoing labor induction for FGR without an increased risk of cesarean delivery or other unfavorable outcomes.

Key Points

  • The cesarean delivery rate was low after the active phase.

  • The labor progress after the active phase was rapid.

  • Oxytocin can be safely discontinued during the active phase.

Keywords

cesarean delivery - fetal growth restriction - labor induction - oxytocin - uterine tachysystole


Publication History

Received: 24 November 2021

Accepted: 18 August 2022

Accepted Manuscript online:
30 August 2022

Article published online:
29 September 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 McCowan LM, Figueras F, Anderson NH. Evidence-based national guidelines for the management of suspected fetal growth restriction: comparison, consensus, and controversy. Am J Obstet Gynecol 2018; 218 (2S): S855-S868
    CrossrefPubMedGoogle Scholar
  • 2 Boers KE, Vijgen SM, Bijlenga D. et al; DIGITAT study group. Induction versus expectant monitoring for intrauterine growth restriction at term: randomised equivalence trial (DIGITAT). BMJ 2010; 341: c7087
    CrossrefPubMedGoogle Scholar
  • 3 Figueras F, Cruz-Martinez R, Sanz-Cortes M. et al. Neurobehavioral outcomes in preterm, growth-restricted infants with and without prenatal advanced signs of brain-sparing. Ultrasound Obstet Gynecol 2011; 38 (03) 288-294
    CrossrefPubMedGoogle Scholar
  • 4 Eixarch E, Meler E, Iraola A. et al. Neurodevelopmental outcome in 2-year-old infants who were small-for-gestational age term fetuses with cerebral blood flow redistribution. Ultrasound Obstet Gynecol 2008; 32 (07) 894-899
    CrossrefPubMedGoogle Scholar
  • 5 Mimura K, Takagi K, Suzuki H, Iriyama T, Seki H. Japan Society for the Study of Hypertension in Pregnancy (JSSHP). Diagnosis and management of fetal growth restriction and uteroplacental dysfunction in hypertensive disorders of pregnancy in Japan: a nationwide survey by the Japan Society for the Study of Hypertension in Pregnancy (JSSHP). Hypertens Res Pregnancy 2022; 10 (01) 8-18
    CrossrefPubMedGoogle Scholar
  • 6 Dansereau J, Joshi AK, Helewa ME. et al. Double-blind comparison of carbetocin versus oxytocin in prevention of uterine atony after cesarean section. Am J Obstet Gynecol 1999; 180 (3, Pt 1): 670-676
    CrossrefPubMedGoogle Scholar
  • 7 Bergum D, Lonnée H, Hakli TF. Oxytocin infusion: acute hyponatraemia, seizures and coma. Acta Anaesthesiol Scand 2009; 53 (06) 826-827
    CrossrefPubMedGoogle Scholar
  • 8 Bahadoran P, Falahati J, Shahshahan Z, Kianpour M. The comparative examination of the effect of two oxytocin administration methods of labor induction on labor duration stages. Iran J Nurs Midwifery Res 2011; 16 (01) 100-105
    PubMedGoogle Scholar
  • 9 Begum LN, Sultana M, Nahar S, Begum R, Barua S. A randomized clinical trial on the need of continuing oxytocin infusion in active phase of induced labour. Chattagram Maa-O-Shisu Hosp Med Coll J 2013; 12: 23-50
    PubMedGoogle Scholar
  • 10 Bor P, Ledertoug S, Boie S, Knoblauch NO, Stornes I. Continuation versus discontinuation of oxytocin infusion during the active phase of labour: a randomised controlled trial. BJOG 2016; 123 (01) 129-135
    CrossrefPubMedGoogle Scholar
  • 11 Chopra S, SenGupta SK, Jain V, Kumar P. Stopping oxytocin in active labor rather than continuing it until delivery: a viable option for the induction of labor. Oman Med J 2015; 30 (05) 320-325
    CrossrefPubMedGoogle Scholar
  • 12 Diven LC, Rochon ML, Gogle J, Eid S, Smulian JC, Quiñones JN. Oxytocin discontinuation during active labor in women who undergo labor induction. Am J Obstet Gynecol 2012; 207 (06) 471.e1-471.e8
    CrossrefPubMedGoogle Scholar
  • 13 Öztürk FH, Yılmaz SS, Yalvac S, Kandemir Ö. Effect of oxytocin discontinuation during the active phase of labor. J Matern Fetal Neonatal Med 2015; 28 (02) 196-198
    CrossrefPubMedGoogle Scholar
  • 14 Rashwan A, Gaafar HM, Maged Mohammed AM. Comparative study between continuous use of oxytocin infusion throughout the active phase of labor versus its discontinuation and its effect on the course of labor. Med J Cairo Univ 2011; 79: 121-125
    PubMedGoogle Scholar
  • 15 Daniel-Spiegel E, Weiner Z, Ben-Shlomo I, Shalev E. For how long should oxytocin be continued during induction of labour?. BJOG 2004; 111 (04) 331-334
    CrossrefPubMedGoogle Scholar
  • 16 Ustunyurt E, Ugur M, Ustunyurt BO, Iskender TC, Ozkan O, Mollamahmutoglu L. Prospective randomized study of oxytocin discontinuation after the active stage of labor is established. J Obstet Gynaecol Res 2007; 33 (06) 799-803
    CrossrefPubMedGoogle Scholar
  • 17 Boie S, Glavind J, Uldbjerg N, Steer PJ, Bor P. CONDISOX trial group. Continued versus discontinued oxytocin stimulation in the active phase of labour (CONDISOX): double blind randomised controlled trial. BMJ 2021;373(716):
    PubMedGoogle Scholar
  • 18 Minakami H, Maeda T, Fujii T. et al. Guidelines for obstetrical practice in Japan: Japan Society of Obstetrics and Gynecology (JSOG) and Japan Association of Obstetricians and Gynecologists (JAOG) 2014 edition. J Obstet Gynaecol Res 2014; 40 (06) 1469-1499
    CrossrefPubMedGoogle Scholar
  • 19 American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 134: fetal growth restriction. Obstet Gynecol 2013; 121 (05) 1122-1133
    CrossrefPubMedGoogle Scholar
  • 20 Horowitz KM, Feldman D. Fetal growth restriction: risk factors for unplanned primary cesarean delivery. J Matern Fetal Neonatal Med 2015; 28 (18) 2131-2134
    CrossrefPubMedGoogle Scholar
  • 21 Savchev S, Figueras F, Cruz-Martinez R, Illa M, Botet F, Gratacos E. Estimated weight centile as a predictor of perinatal outcome in small-for-gestational-age pregnancies with normal fetal and maternal Doppler indices. Ultrasound Obstet Gynecol 2012; 39 (03) 299-303
    CrossrefPubMedGoogle Scholar
  • 22 Cruz-Martínez R, Figueras F, Hernandez-Andrade E, Oros D, Gratacos E. Fetal brain Doppler to predict cesarean delivery for nonreassuring fetal status in term small-for-gestational-age fetuses. Obstet Gynecol 2011; 117 (03) 618-626
    CrossrefPubMedGoogle Scholar
  • 23 Sovio U, White IR, Dacey A, Pasupathy D, Smith GCS. Screening for fetal growth restriction with universal third trimester ultrasonography in nulliparous women in the Pregnancy Outcome Prediction (POP) study: a prospective cohort study. Lancet 2015; 386 (10008): 2089-2097
    CrossrefPubMedGoogle Scholar
  • 24 Nwabuobi C, Gowda N, Schmitz J. et al. Risk factors for cesarean delivery in pregnancy with small-for-gestational-age fetus undergoing induction of labor. Ultrasound Obstet Gynecol 2020; 55 (06) 799-805
    CrossrefPubMedGoogle Scholar
  • 25 Murata S, Nakata M, Sumie M, Sugino N. The Doppler cerebroplacental ratio predicts non-reassuring fetal status in intrauterine growth restricted fetuses at term. J Obstet Gynaecol Res 2011; 37 (10) 1433-1437
    CrossrefPubMedGoogle Scholar
  • 26 Saccone G, Ciardulli A, Baxter JK. et al. Discontinuing oxytocin infusion in the active phase of labor: a systematic review and meta-analysis. Obstet Gynecol 2017; 130 (05) 1090-1096
    CrossrefPubMedGoogle Scholar
  • 27 Hernández-Martínez A, Arias-Arias A, Morandeira-Rivas A, Pascual-Pedreño AI, Ortiz-Molina EJ, Rodriguez-Almagro J. Oxytocin discontinuation after the active phase of induced labor: a systematic review. Women Birth 2019; 32 (02) 112-118
    CrossrefPubMedGoogle Scholar
  • 28 Austad FE, Eggebø TM, Rossen J. Changes in labor outcomes after implementing structured use of oxytocin augmentation with a 4-hour action line. J Matern Fetal Neonatal Med 2021; 34 (24) 4041-4048
    CrossrefPubMedGoogle Scholar
  • 29 Rossen J, Østborg TB, Lindtjørn E, Schulz J, Eggebø TM. Judicious use of oxytocin augmentation for the management of prolonged labor. Acta Obstet Gynecol Scand 2016; 95 (03) 355-361
    CrossrefPubMedGoogle Scholar
  • 30 Suzuki S. Clinical significance of precipitous labor. J Clin Med Res 2015; 7 (03) 150-153
    CrossrefPubMedGoogle Scholar
  • 31 Reuter S, Moser C, Baack M. Respiratory distress in the newborn. Pediatr Rev 2014; 35 (10) 417-428 , quiz 429
    CrossrefPubMedGoogle Scholar
  • 32 American College of Obstetricians and Gynecologists; Society for Maternal-Fetal Medicine. Obstetric care consensus no. 1: safe prevention of the primary cesarean delivery. Obstet Gynecol 2014; 123 (03) 693-711
    CrossrefPubMedGoogle Scholar
  • 33 Becker DA, Szychowski JM, Kuper SG, Jauk VC, Wang MJ, Harper LM. Labor curve analysis of medically indicated early preterm induction of labor. Obstet Gynecol 2019; 134 (04) 759-764
    CrossrefPubMedGoogle Scholar