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 long been used for the induction of labor, but it 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, once the active phase of induced labor is achieved, affects the second stage of labor and the rate of various maternal and fetal outcomes.

Methods: We searched for randomized controlled trials (RCTs) comparing discontinuing oxytocin after the active stage of labor is established versus continuing to give oxytocin throughout the labor process using databases like PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov from the inception till February 1, 2025. Results were pooled using RevMan 5.4, and the effect metric was the risk ratio (RR). Our systematic review and meta-analysis was registered with PROSPERO (CRD42024534076).

Results: Pooled analysis of fifteen RCTs 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 was significantly lower in the oxytocin discontinuation group compared to oxytocin continuation. The rates of uterine rupture, vaginal instrument use, epidural use, and neonatal intensive care unit 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: Discontinuation of oxytocin during the active phase of labor did not reduce the incidence of cesarean 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 to provide more reliable results.