Induction of labour: a randomised clinical trial of amniotomy versus amniotomy with oxytocin infusion.

British journal of obstetrics and gynaecology

PubMedID: 8605125

Moldin PG, Sundell G. Induction of labour: a randomised clinical trial of amniotomy versus amniotomy with oxytocin infusion. Br J Obstet Gynaecol. 1996;103(4):306-12.
OBJECTIVE
To compare two methods of induction of labour-amniotomy with oxytocin infusion versus amniotomy alone.

DESIGN
Prospective randomised clinical trial.

SETTING
The department of obstetrics in a Swedish central hospital.

PARTICIPANTS
One hundred and ninety-six pregnant women with indication for induction of labour at term and a favourable cervix (modified Bishop score > or = 6).

INTERVENTIONS
The women were randomised to amniotomy followed by oxytocin infusion after 1 h (group A, n = 98) or amniotomy alone (group B, n = 98). If labour had not ensued on the following morning, after approximately 24 h, the women in group B were given an oxytocin infusion.

MAIN OUTCOME MEASURES
Induction-delivery interval, duration of labour, time spent in delivery ward, oxytocin use, maternal and neonatal clinical outcome.

RESULTS
Amniotomy combined with early oxytocin infusion resulted in shorter induction-delivery interval (median 6.0 h; 95% confidence interval (CI) 5.0 to 6.5 h) than amniotomy alone (median 9.0 h; 95% CI 7.5 to 10.0 h). This was due to a shorter latent period in the former group (median 2.3 h; 95% CI 2.0 to 3.0 h) compared to the latter (median 4.3 h; 95% CI 3.0 to 5.5 h). The duration of labour stages 1 and 2 were similar in both groups. The time spent in the delivery ward was slightly reduced for women managed by amniotomy alone (median 5.0 h; 95% CI 4.5 to 6.0 h) compared with those managed by the combination of amniotomy and oxytocin infusion (median 6.0 h; 95% CI 5.0 to 6.5 h). Eighty-seven percent in group A and 32% in group B were given oxytocin, and the total oxytocin infusion time was nearly five times longer in group A. No other important effect on maternal or fetal outcomes was demonstrated.

CONCLUSION
With regard to safety the results do not warrant recommending either type of labour induction. The minor differences observed between the induction groups justify an individual management policy, with attention paid to both the indication for induction of labour and the woman's choice.