Ceasing oxytocin in the active phase of the first stage of induced labours: A prospective audit at a tertiary hospital.

Introduction: Oxytocin is commonly used in the process of induction of labour and is associated with uterine hyperstimulation and abnormal fetal heart rate patterns that can increase the risk of adverse perinatal outcomes. Cessation of oxytocin in the active phase of induced labour has been shown in randomised trials to reduce uterine tachysystole and abnormal fetal heart rate traces, and may reduce caesarean section. We introduced a policy recommending cessation of oxytocin infusion in the active phase of the first stage of induced labour at a tertiary hospital in Sydney, Australia, and collated both clinical outcomes and maternal satisfaction following implementation. Methods: This was a prospective audit of a policy change at Royal Prince Alfred Hospital, comparing 600 women induced with oxytocin in the 6 months before the policy (November 2019 to May 2020) with 556 women induced in the 6 months after implementation (June to December 2020). Eligible women had a cervix [≥] 5cm, an oxytocin infusion, and regular uterine contractions. The primary clinical outcome was caesarean delivery. The primary patient-centred outcome, maternal satisfaction, measured using the Six Simple Questions questionnaire, was collected in a subset of participants. Secondary outcomes included mode of birth, length of labour, uterine hyperstimulation, and perinatal outcomes. Results: Caesarean delivery occurred in 29% of women before and 28% after policy implementation (p=0.77). Instrumental birth increased from 25% to 27%; and instrumental birth for maternal indications increased from 6.8% to 13% (p=0.0005). Median length of labour increased by one hour (5.4 vs 6.4 hours, p=0.006). Oxytocin was ceased for at least two hours or until birth in 13% of women before the policy versus 35% after. Maternal satisfaction scores were modestly lower after implementation (median 41 vs 38, p=0.03). Perinatal outcomes, including abnormal cord gases, Apgar scores, and NICU admission, were similar between groups. Conclusions: Implementing a policy of recommending cessation of oxytocin in the active phase of induced labour did not reduce caesarean delivery rates in a real-world tertiary hospital setting, despite trial-level evidence supporting the intervention. Poor uptake, negative staff perceptions, and a modest reduction in maternal satisfaction highlight barriers to translating trial efficacy into routine clinical practice. Adequately powered trials are needed to clarify optimal protocols for oxytocin cessation and its effects on maternal and perinatal outcomes.