Oxytocin use increases risk of uterine rupture in trial of l
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This study has demonstrated the risk association between oxytocin use in the trial of labor after a previous cesarean delivery and uterine rupture. The researcher also found that the process of induction or cervix condition might influence the effect of oxytocin on uteruses with a scar. Based on the results, simplified and standardized intrapartum management and cautiously monitoring of oxytocin use could help to avoid some maternal and neonatal complications. On the other hand, more studies are needed to explore how oxytocin affects the process of trial of labor after a previous cesarean delivery. It is necessary to consider the precise initial dose, maximum dose, the interval to dose increase, and duration of oxytocin to reduce possible risk and enhance the safety of trial of labor after a previous cesarean delivery.

A trial of labor after a previous cesarean delivery has reduced the rate of cesarean sections. Nevertheless, the widespread use of trial of labor after a previous cesarean delivery has been limited by an increase in adverse outcomes, the most serious one being the risk of symptomatic uterine rupture, which is possibly associated with oxytocin. In this meta-analysis, we explored the risk association between oxytocin use and uterine rupture in the trial of labor after a previous cesarean delivery.

Multiple electronic databases were searched for cross-sectional studies reporting on the trial of labor after a previous cesarean delivery, oxytocin, and uterine rupture. A total of 14 studies, which included 48,457 women who underwent a trial of labor after a previous cesarean delivery, met the inclusion criteria. The pooled rate of vaginal birth after a cesarean section and the rate of uterine rupture in spontaneous labor were 74.3 and 0.7%, respectively. In addition, the pooled rate of vaginal birth after a cesarean section and the rate of uterine rupture in the induction labor group was 60.7 and 2.2%, respectively.

The women who had spontaneous labor had a significantly higher rate of vaginal birth after a cesarean section and a lower rate of uterine rupture compared to induced labor. The pooled rates of uterine rupture in women using oxytocin and women not using oxytocin in a trial of labor after a previous cesarean delivery were 1.4% and 0.5%, respectively, and the difference was significant. Also, the synthetic rate of uterine rupture in oxytocin augmentation among women with spontaneous labor and women who had a successful induction of labor were 1.7% and 2.2%, respectively, without significant difference.

Source:https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-020-03440-7
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