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Title: The timing of amniotomy, oxytocin and neuraxial analgesia and its association with labour duration and mode of birth
Authors : Gross, Mechthild Maria
Frömke, Cornelia
Hecker, Hartmut
Published in : Archives of Gynecology and Obstetrics
Volume(Issue) : 289
Issue : 1
Pages : 41
Pages to: 48
Publisher / Ed. Institution : Springer
Issue Date: 2014
License (according to publishing contract) : Licence according to publishing contract
Type of review: Peer review (Publication)
Language : English
Subjects : Analgesia; Epidural analgesia; Cesarean section; Cohort studies; Labor onset; Induced labor; Obstetric labor; Longitudinal study; Oxytocic; Pain management; Parturition; Pregnancy; Treatment outcome; Obstetric delivery; Extraembryonic membranes
Subject (DDC) : 618.4: Childbirth
Abstract: Purpose The objective was to study the association of different timings of intrapartum interventions with labour duration and mode of birth. Methods A longitudinal cohort study of 2,090 nulliparae and 1,873 multiparae with a singleton in cephalic presentation was conducted. We assessed the association between, on the one hand, the timing of augmentation with oxytocin, neuraxial analgesia and amniotomy, and, on the other hand, the time to complete dilatation, spontaneous or operative vaginal delivery or caesarean delivery, using a Cox regression model accounting for standard confounders. Results From amniotomy onwards labour was accelerated. In multiparae, amniotomy was associated with an initial 6.6-fold acceleration, decreasing first stage duration until the hazard ratio reached around 3.5, where the intervention was performed 5 h after labour onset; thereafter, acceleration continued with a hazard ratio of around 3. In nulliparae, neuraxial analgesia was associated with a shorter first stage when administered between 7 and 11 h after labour onset; the later it was performed, the less likely was spontaneous birth and the more likely an operative vaginal birth in nulliparae or a caesarean section in multiparae. The start of oxytocin augmentation was associated with acceleration towards both full dilatation and caesarean section during first stage and an increased risk of operative vaginal birth during second stage. The later oxytocin augmentation started, the more likely it was that spontaneous birth would be retarded in multiparous women. Conclusions Applying amniotomy, oxytocin and neuraxial analgesia at their optimal timing may improve the progress and outcome of labour.
Further description : Erworben im Rahmen der Schweizer Nationallizenzen (
Departement: Gesundheit
Organisational Unit: Institute of Midwifery (IHB)
Publication type: Article in scientific Journal
DOI : 10.1007/s00404-013-2916-7
ISSN: 0932-0067
Restricted until : 2019-01-01
Appears in Collections:Publikationen Gesundheit

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