Pulsatile versus continuous administration of oxytocin for induction and augmentation of labor: two randomized controlled trials

Objective To determine whether pulsatile oxytocin infusion improves delivery outcome in women requiring induction or augmentation of labor. Study Design Two related randomized controlled trials undertaken in 2 inner-city United Kingdom university hospitals (ISRCTN72773405; http://www.isrctn.org/). Women were randomly assigned to a pulsatile or continuous infusion protocol. Primary outcome: cesarean section rate (induction trial); operative delivery rate (augmentation trial). Results For induction, cesarean section rates were similar in women receiving pulsatile (n = 264, 38.3%) vs continuous infusion of oxytocin (n = 257; 37.7%; risk ratio, 1.01; 95% confidence interval, 0.81–1.26; P = .903), but associated with increased "infusion to time of delivery" intervals ( P P = .077) and increased neonatal morbidity. Conclusion For induction, pulsatile infusion of oxytocin is effective, but conferred little clinical benefit. Pulsatile infusion is not recommended for augmentation.