Induction of labor with pulsatile oxytocin by a computer-controlled pump.

OBJECTIVE

The objective was to test the safety and efficacy of a pulsatile oxytocin infusion protocol in which a computer-controlled pump adjusts the oxytocin dose rate on the basis of uterine activity.

STUDY

DESIGN

A total of 358 women were enrolled in, and 310 completed, a prospective, randomized clinical trial comparing three protocols for the induction of labor with oxytocin: aggressively managed continuous infusion, conservatively managed continuous infusion, and computer-controlled pulsatile infusion. Results were analyzed with Student t and chi 2 "goodness-of-fit" tests.

RESULTS

Mean doses of oxytocin in the group receiving pulsed oxytocin were approximately 20% of the dose rates in the continuous infusion protocols. All protocols effectively established labor in the majority of patients, although nulliparous women with unfavorable Bishop scores were more likely to fail to establish labor within a 24-hour period when treated with the aggressive continuous protocol. There were no differences in the rates of cesarean section, hyperstimulation, blood gases, or Apgar scores among the three treatment groups.

CONCLUSIONS

Oxytocin dosage was minimized by use of a computer-controlled pump. With the exception of aggressively managed nulliparous women, there were no differences in the percentages of patients with successful inductions among the three protocols. The percentage of successful inductions was lower for aggressively managed nulliparous women than for other patient and protocol groups.