Oxytocin discontinuation after the active phase of induced labour: an overview of systematic reviews.

Abstract

Background: To synthesize the available evidence on the effects of discontinuing oxytocin after the onset of the active phase of induced labour.

Methods: An overview of seven systematic reviews (SRs) and meta-analyses was conducted. Maternal and neonatal outcomes were extracted, and the methodological quality of reviews was assessed using AMSTAR. Primary study overlap among systematic reviews was quantified using the corrected covered area (CCA).

Results: Discontinuation of oxytocin after the active phase was associated with a reduction in cesarean delivery in six SRs. Uterine tachysystole was significantly reduced across all SRs. Nonreassuring fetal heart rate (FHR) patterns were more frequent in the oxytocin continuation groups. Findings for postpartum hemorrhage were inconsistent. Neonatal outcomes, including Apgar score < 7 at 5 min, cord blood pH < 7.10, neonatal asphyxia, and NICU admission, showed no significant differences between groups. Discontinuation was also associated with a modest prolongation of the active phase. Using the AMSTAR tool, all SRs demonstrated high methodological quality (mean score 9.2; range 8-11). However, the seven systematic reviews were highly redundant, largely analyzing the same 15 unique primary RCTs (corrected covered area = 64.4%).

Conclusion: Discontinuing oxytocin after the active phase of labour may reduce maternal complications, particularly uterine tachysystole, without compromising most neonatal outcomes. However, the certainty of the evidence is limited by heterogeneity in oxytocin protocols, substantial overlap among the included systematic reviews and their primary trials, and the relatively small number of unique randomized controlled trials. Further high-quality randomized controlled trials using standardized oxytocin regimens are needed to provide more definitive evidence.

Clinical trial number: Not applicable.