Reduced Cesarean Risk with Oxytocin Discontinuation in Labor : ystematic Review and Meta-Analysis

A systematic review and meta-analysis was carried out after a thorough search of electronic databases up to February 2024, with the study protocol registered in PROSPERO.

The analysis included randomized controlled trials of pregnant women who received oxytocin for either induction or augmentation of labor, comparing outcomes between continuation and discontinuation during the active phase. Nonrandomized studies, quasi-randomized trials, and animal research were excluded. The main outcome of interest was the rate of cesarean delivery. Secondary maternal outcomes examined postpartum hemorrhage, total blood loss, and infections, while neonatal outcomes assessed Apgar score less than 7 at five minutes, low umbilical arterial pH, therapeutic hypothermia, intensive care admission, resuscitation at birth, and neonatal death.

According to Cochrane recommendations the risk of bias was evaluated , and heterogeneity was measured with Higgins I². Data were synthesized using Review Manager and Stata to calculate pooled effects. Fifteen randomized trials with 5734 participants were included. Thirteen of these reported cesarean delivery, which was significantly reduced with oxytocin discontinuation (relative risk 0.80; 95% CI, 0.66–0.97). Discontinuation also lowered the risk of uterine tachysystole and nonreassuring fetal heart rate patterns, though it prolonged active labor by about 30 minutes and the second stage by roughly 6 minutes.

The findings concluded that , oxytocin discontinuation during active labor reduced the risk of cesarean delivery and certain adverse maternal-fetal outcomes, although the reliability of the pooled effect depended on the quality of the included studies. 

Reference:

1. Whitley J, Burd J, Doering M, Kelly J, Frolova A, Raghuraman N. Reduced risk of cesarean delivery with oxytocin discontinuation in active labor: a systematic review and meta-analysis. Am J Obstet Gynecol. 2025 Jul;233(1):25-39.e11. doi: 10.1016/j.ajog.2025.03.015. PMID: 40113155. : https://www.ajog.org/article/S0002-9378(25)00161-9/fulltext)