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Article Dans Une Revue Journal of Gynecology Obstetrics and Human Reproduction Année : 2020

Evaluation of the implementation of a protocol for the restrictive use of oxytocin during spontaneous labor

Résumé

Introduction: Use of oxytocin is associated with uterine hyperstimulation and postpartum hemorrhage with a dose-dependent effect. We aimed to evaluate the effect of the implementation of a protocol for the restrictive use of oxytocin during spontaneous labor on obstetric and neonatal outcomes. Material and methods: We performed an observational before-and-after study among 2174 women in spontaneous labor with a term singleton cephalic fetus. Obstetric and neonatal outcomes were compared according to the period, before (period A) and after (period B) the implementation of a protocol for the restrictive use of oxytocin. Results: 1235 women were included in period A and 939 in period B. Compared to period A, the use of oxytocin during period B was significantly lower (45.5 vs. 35.1%, p<0.001) in both nulliparous (61.2 vs 54.6%, p=0.04) and multiparous women (34.0 vs. 21.1%, p<0.001). Labor was significantly longer in period B, both in nulliparous (6.7 vs. 7.9 h, p<0.01) and multiparous women (4.1 vs. 4.5 h, p<0.01). A lower frequency of uterine hyperstimulation (6.6 vs. 2.7%, p=0.01) was observed in period B. The odds of instrumental and cesarean delivery were not different between the periods (respectively adjusted odds ratio (AOR), 95% confidence interval (CI), 1.1(0.8-1.4); 1.2(0.8-1.8)) including for nulliparous women (respectively, 1.3(0.9-1.7); 1.3(0.8-1.9)). Discussion: Reducing the use of oxytocin during spontaneous labor through the implementation of a protocol may reduce the iatrogenic effects without increasing the risk of caesarean section but this implies longer duration of labor.
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hal-03490115 , version 1 (21-07-2022)

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Paternité - Pas d'utilisation commerciale

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Pauline Blanc-Petitjean, Hélène Legardeur, Géraldine Meunier, Laurent Mandelbrot, Camille Le Ray, et al.. Evaluation of the implementation of a protocol for the restrictive use of oxytocin during spontaneous labor. Journal of Gynecology Obstetrics and Human Reproduction, 2020, 49 (2), pp.101664. ⟨10.1016/j.jogoh.2019.101664⟩. ⟨hal-03490115⟩
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