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  • Title: Pulsatile versus continuous administration of oxytocin for induction and augmentation of labor: two randomized controlled trials.
    Author: Tribe RM, Crawshaw SE, Seed P, Shennan AH, Baker PN.
    Journal: Am J Obstet Gynecol; 2012 Mar; 206(3):230.e1-8. PubMed ID: 22206748.
    Abstract:
    OBJECTIVE: To determine whether pulsatile oxytocin infusion improves delivery outcome in women requiring induction or augmentation of labor. STUDY DESIGN: Two related randomized controlled trials undertaken in 2 inner-city United Kingdom university hospitals (ISRCTN72773405; http://www.isrctn.org/). Women were randomly assigned to a pulsatile or continuous infusion protocol. PRIMARY OUTCOME: cesarean section rate (induction trial); operative delivery rate (augmentation trial). RESULTS: For induction, cesarean section rates were similar in women receiving pulsatile (n = 264, 38.3%) vs continuous infusion of oxytocin (n = 257; 37.7%; risk ratio, 1.01; 95% confidence interval, 0.81-1.26; P = .903), but associated with increased "infusion to time of delivery" intervals (P < .001) in the pulsatile group. For augmentation, pulsatile infusion resulted in higher operative delivery rates (70.1%, n = 251) vs continuous infusion (62.7%, n = 249; risk ratio, 1.12; 95% confidence interval, 0.99-1.27; P = .077) and increased neonatal morbidity. CONCLUSION: For induction, pulsatile infusion of oxytocin is effective, but conferred little clinical benefit. Pulsatile infusion is not recommended for augmentation.
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