Early amniotomy and early oxytocin reduce caesarean section rate

Clinical question: 
How effective are early amniotomy and early oxytocin for prevention or therapy for delay in labour progress, with respect to the caesarean birth rate and indicators of maternal and neonatal morbidity?
Bottom line: 
This review showed that a policy of early routine augmentation for mild delays in labour progress resulted in a modest reduction in the caesarean section rate compared with routine care. The caesarean section rate was reduced in the 10 trials looking at prevention of abnormal progression. The difference in caesarean risk was 1.47%. NNT* 68 (34 to 3099) to prevent one caesarean section. In these women, the time from admission to giving birth was also reduced (mean difference 1.1 hour). There was no reduction in caesarean rate in the 2 trials using amniotomy and oxytocin as treatment for non-progressing labour. *NNT = number needed to treat to benefit one individual (95% confidence interval)
Caveat: 
The trials did not provide sufficient evidence on indicators of maternal or neonatal health, including women's satisfaction and views on the experience. Documentation of other aspects of care, such as continuous professional support, mobility and positions during labour, was limited. Women in the control group also received oxytocin but often later than in the intervention group. The severity of delay which was sufficient to justify interventions remains to be defined.
Context: 
Caesarean section rates are over 20% in many developed countries. The main diagnosis contributing to the high rate in nulliparous women is dystocia or prolonged labour. The present review assesses the effects of a policy of early amniotomy with early oxytocin administration for the prevention or therapy for delay in labour progress.
Review CD#: 
CD006794
PEARLS No: 
192
Date: 
August, 2009
Authored by: 
Brian R McAvoy