Role of Oxytocin in the Second Stage of Labor: a Randomized Controlled Trial (The ROSSoL Trial)
Washington University School of Medicine
Summary
This is a randomized controlled trial investigating the utility of oxytocin administration in the second stage of labor.
Description
Oxytocin is widely used on Labor and Delivery units throughout the world.Laboring patients are most likely to initiate oxytocin in the first stage of labor. Among those who receive oxytocin, first stage initiation is far more common than second stage initiation. The goal of first stage administration is to increase uterine contractility and cause cervical dilation, particularly in patients who have epidural analgesia. Once complete cervical dilation has been achieved, most providers choose to continue oxytocin in the second stage of labor for the theoretic benefit of increased expulsion "power…
Eligibility
- Age range
- Not specified
- Sex
- Female
- Healthy volunteers
- Yes
Inclusion Criteria: * Nulliparous pregnant women \>/= 37 weeks gestation * Singleton pregnancies * Admission for induction of labor or spontaneous labor Exclusion Criteria: * Multiple gestations * Multiparous patients * Patients with major fetal anomalies * Not on oxytocin at the time of complete cervical dilation * Patients with fetal head visible at the perineum on diagnosis of complete cervical dilation * Maternal medical condition that prohibits prolonged second stage
Interventions
- DrugContinue Oxytocin
The administration and titration of oxytocin for labor augmentation is per a hospital based protocol. To summarize, oxytocin is initiated intravenously at 2 milliunits/minute and increased by 2 milliunits/minute every 20 minutes until an adequate contraction pattern is attained or a maximum of 40 millunits/minute has been achieved. This protocol for titration and administration will be applied in this study to the oxytocin group. The intravenous pumps on Labor and Delivery have automated functions for intravenous administration of oxytocin that is milliunit-based and the same routine pumps will be used in this study. The study bag will be administered per current oxytocin protocol. Since patients will already be on oxytocin at time of randomization, their current bag of oxytocin will be continued by the primary provider at a rate of their discretion.
- OtherDiscontinue Oxytocin
Patients will have their oxytocin discontinued in the second stage of labor. The patient will receive routine maintenance IV fluids per the discretion of the provider.
Location
- Barnes Jewish HospitalSt Louis, Missouri