HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by GOETZL, L. Articles by LIEBERMAN, E. Search for Related Content PubMed PubMed Citation Articles by GOETZL, L. Articles by LIEBERMAN, E.

Oxytocin Dose and the Risk of Uterine Rupture in Trial of Labor After Cesarean

From the Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas; the Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts; the Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, Massachusetts; and the Departments of Obstetrics and Gynecology, University of Nebraska Medical Center, Omaha, Nebraska.

Address reprint requests to: Laura Goetzl, MD, MPH, 1921 North Boulevard, Houston, TX 77098, E-mail: lgoetzl{at}hotmail.com

Objective: To examine the association between uterine rupture and oxytocin use in trial of labor after cesarean.

Methods: A case-control study was performed. Cases were all women with uterine ruptures who received oxytocin during a trial of labor after a single cesarean delivery within a 12-year period (n = 24). Four controls undergoing trial of labor after a single cesarean delivery were matched to each case by 500 g birth weight category, year of birth, and by induction or augmentation (n = 96). The study had an 80% power to detect a 40% increase in oxytocin duration or a 65% increase in total oxytocin dose.

Results: No significant differences were seen in initial oxytocin dose, maximum dose, or time to maximum dose. Although women with uterine ruptures had higher exposure to oxytocin as measured by mean total oxytocin dose (544 mU higher) and oxytocin duration (54 minutes longer), these differences were not statistically significant. Women with uterine rupture who received oxytocin were more likely to have experienced an episode of uterine hyperstimulation (37.5% compared with 20.8%, P = .05). However, the positive predictive value of hyperstimulation for uterine rupture was only 2.8%.

Conclusion: Although no significant differences in exposure to oxytocin were detected between cases of uterine rupture and controls, the rarity of uterine rupture limited our power to detect small differences in exposure. In women receiving oxytocin, uterine rupture is associated with an increase in uterine hyperstimulation, but the clinical value of hyperstimulation for predicting uterine rupture is limited.