Amniotomy plus intravenous oxytocin for induction of labour
Evidence SummariesLevel of Evidence = C
Amniotomy and intravenous oxytocin may enhance delivery compared to amniotomy alone, but they may be less safe than vaginal prostaglandins.
A Cochrane review 1 included 17 trials involving 2,566 women. In a single study of 100 women amniotomy and intravenous oxytocin resulted in fewer women being undelivered vaginally at 24 hours than amniotomy alone (RR 0.03, 95% CI 0.001–0.49). Amniotomy and intravenous oxytocin resulted in significantly fewer instrumental vaginal deliveries than placebo (RR 0.18, 95% CI 0.05–0.58). In two studies comparing amniotomy and oxytocin with vaginal PGs (amniotomy or oxytocin was added to PGs in case of no spontaneous labour) there were more postpartum haemorrhage (13.75% vs 2.5%, RR 5.5, 95% CI 1.26–24.07, 160 women).
Comment: The quality of evidence is downgraded by imprecise results (limited study size for each comparison) and by indirectness (no single study addressed all the primary outcomes).
1. Howarth GR, Botha DJ. Amniotomy plus intravenous oxytocin for induction of labour. Cochrane Database Syst Rev 2001;(3):CD003250. [PMID:11687061]
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