Use and abuse of oxytocin for augmentation of labor

Objective. To investigate the use of oxytocin for augmentation of labor and its relation to labor progress and delivery outcome. Design and setting. A retrospective observational study undertaken in a Swedish hospital during 2000–2001. Sample. Singleton pregnancies at ≥ 37 weeks of gestation with cephalic presentation and spontaneous onset of labor. Methods. Data were collected from 1,263 clinical records. The partogram was used to diagnose labor dystocia (LD). Main outcome measures. Prevalence of oxytocin administration, LD and operative delivery. Results. Oxytocin was administered to 55% of the women (75% of primiparas and 38.1% of multiparas); a majority did not meet LD criteria. LD frequency was 19.8% (32.7% in primiparas and 7.4% in multiparas). Oxytocin was started both ‘too early’ and ‘too late’ in relation to the diagnosis of LD. Cesarean section (CS) was performed on 17.1% of primiparous and 2.4% of multiparous oxytocin recipients with LD, compared to 2.3 and 1.5%, respectively, of oxytocin recipients without diagnosed LD. Conclusions. Oxytocin augmentation was undertaken in an unstructured manner; some women were inadequately treated and others were treated unnecessarily. Oxytocin recipients with LD underwent operative delivery to a higher extent than oxytocin recipients without LD, suggesting that the main reason for CS was the underlying problem of LD rather than the oxytocin augmentation itself.