Continued versus discontinued oxytocin in the active phase of induced labor in term pregnancies: an updated systematic review and meta-analysis of randomized controlled trials.

Abstract

Introduction Oxytocin has been long used for induction labor but can be associated with fetal and maternal complications that could potentially be reduced by discontinuing the treatment during labor. We performed this meta-analysis to determine whether discontinuation of oxytocin stimulation, once the active phase of induced labor is achieved, affects the second stage of labor and the rates of various maternal and fetal outcomes. Methods We searched PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov from inception to 1st February 2025 for randomized controlled trials (RCTs) comparing discontinuation of oxytocin once the active stage of labor is established to continuous oxytocin administration throughout the labor. RevMan 5.4 was used to pool outcomes with risk ratio (RR) as the effect measure. Our Meta-analysis was registered with PROSPERO (CRD42024534076). Results Pooled analysis of fifteen randomized controlled trials included in our review showed that discontinuation of oxytocin, once the active stage of labor is established, did not reduce the primary outcome of incidence of cesarean delivery (RR= 0.91; 95% CI, 0.77-1.07; P=0.21). The incidence of uterine tachysystole, postpartum hemorrhage, and non-reassuring fetal heart rate were significantly lower in the oxytocin discontinuation group. The rates of uterine rupture, vaginal instrument use, epidural use, and neonatal intensive care unit (NICU) admission did not differ among both groups. The duration of the active stage of labor was significantly prolonged in the oxytocin-discontinued group, however, the duration of the second stage of labor and total delivery time remained comparable between the two groups. Conclusions: In conclusion, discontinuation of oxytocin during the active phase of labor did not reduce the incidence of caesarean section or neonatal morbidity. We therefore recommend an individualized approach regarding oxytocin discontinuation while factoring in patient-specific factors. New large-scale RCTs focusing on identifying subgroups that might benefit from one approach over the other are required provide more reliable results.