Early versus delayed oxytocin infusion following amniotomy for induction of labor: a meta-analysis of randomized controlled trials

Background Oxytocin infusion prior to confirmation of delay in labor is discouraged by the World Health Organization. However, evidence from the Cochrane library seems to support early amniotomy and oxytocin to reduce the rates of cesarean sections (CS). Objectives To investigate differences in mode of delivery among parturient receiving early versus delayed oxytocin infusion following amniotomy as a mean for augmentation of labor. Search strategy We searched Medline, Scopus, EMBASE, Cochrane Central Register of Controlled Trials and Google Scholar databases from inception till February 2020. Selection criteria: Randomized controlled trials. Data collection and analysis Data were collected using a modified Cochrane data collection form for intervention reviews. Meta-analysis was performed using the meta function in RStudio. Main results Five studies were included that involved 1.232 parturient. The meta-analysis did not reveal significant differences in the mode of delivery among women that were randomized to receive immediate oxytocin infusion and those that received delayed oxytocin infusion (operative vaginal delivery OR 1.14, 95% CI 0.48, 2.69) and CS OR 0.81, 95% CI 0.53, 1.25)). The interval from amniotomy to delivery was significantly smaller in the immediate oxytocin infusion group; however, prediction intervals were not significant. Conclusions The results of our meta-analysis suggest that there is no difference in the mode of delivery and interval from amniotomy to delivery when oxytocin is delayed for at least one hour following amniotomy. Taking in mind this information as well as current recommendations drawn from the WHO physicians should consider withholding oxytocin infusion at least until protracted labor is confirmed.