RESEARCH PAPER
Oxytocin and emergency caesarean section in a medium-sized hospital in Pakistan: A cross-sectional study
 
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1
Institute of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
2
Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Borre, Norway
3
Women's Christian Hospital, Multan, Pakistan
CORRESPONDING AUTHOR
Mirjam Lukasse   

Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South- Eastern Norway, Raveien 215, Borre, 3184, Norway
Submission date: 2020-02-17
Final revision date: 2020-05-15
Acceptance date: 2020-06-17
Publication date: 2020-08-06
 
Eur J Midwifery 2020;4(August):33
 
KEYWORDS
TOPICS
ABSTRACT
Introduction:
One of the most common complications during labour is prolonged labour (dystocia) which is associated with risks for the mother and fetus. Dystocia is usually treated with Oxytocin. Oxytocin is also used to induce labour. Oxytocin may not have the desired effect of progress and can negatively affect the fetus, thus resulting in an emergency Caesarean Section (CS). The aim of this study was to describe obstetric practice, use of oxytocin and it's association with an emergency CS.

Methods:
A cross-sectional retrospective register study was conducted that included all women who gave birth during 2014 and 2015 at a hospital in a large city in Pakistan.

Results:
A total of 6652 women gave birth to 6767 newborns, 66.8% were multiparous and 33.2% primiparous women. Of the primiparous women, 78.9% had a spontaneous vaginal birth, 1.2% an elective CS and 14.4% an emergency CS. Of the multiparous women, 81.9% had a spontaneous vaginal birth, 8.0% an elective CS and 6.7% an emergency CS. Operative vaginal birth was 2.1% among primiparous and 0.2% among multiparous women. Oxytocin for induction or augmentation was administered to 60.0% of primiparous and 30.5% of multiparous women. Oxytocin during the first stage of labor was associated with an increased risk for emergency CS for both primiparous and multiparous women.

Conclusions:
Despite the association between oxytocin and emergency CS, the CS rate was low in this hospital. The majority of the women gave birth vaginally, even with a breech presentation. Few operative vaginal births were performed.

CONFLICTS OF INTEREST
The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported.
FUNDING
Research time for ML was paid by Oslo Metropolitan University.
AUTHORS' CONTRIBUTIONS
ML, MM, IH and SB perceived the design of the study. MM and SMcA collected the data. IH and SB cleaned the data and performed the analyses agreed upon by all authors. IH, SB, ML, SMcA and MM interpreted the results. ML, IH and SB were involved in the writing of the manuscript. All authors approved the final manuscript.
PROVENANCE AND PEER REVIEW
Not commissioned; externally peer reviewed.
 
REFERENCES (39)
1.
Snow RC, Laski L, Mutumba M. Sexual and reproductive health: Progress and outstanding needs. Global Public Health. 2015;10(2):149-173. doi:10.1080/17441692.2014.986178
 
2.
McClure EM, Saleem S, Goudar SS, et al. Stillbirth rates in low-middle income countries 2010 - 2013: a population-based, multi-country study from the Global Network. Reproductive health. 2015;12(Suppl 2):S7. doi:10.1186/1742-4755-12-S2-S7
 
3.
Agha S. Impact of a maternal health voucher scheme on institutional delivery among low income women in Pakistan. Reprod Health. 2011;8(1):10. doi:10.1186/1742-4755-8-10
 
4.
Abbas F, Ud Din RA, Sadiq M. Prevalence and determinants of Caesarean delivery in Punjab, Pakistan. East Mediterr Health J. 2019;24(11):1058-1065. doi:10.26719/2018.24.11.1058
 
5.
Nystedt A, Hildingsson I. Diverse definitions of prolonged labour and its consequences with sometimes subsequent inappropriate treatment. BMC Pregnancy Childbirth. 2014;14(10):233. doi:10.1186/1471-2393-14-233
 
6.
Karacam Z, Walsh D, Bugg GJ. Evolving understanding and treatment of labour dystocia. Eur J Obstet Gynecol Reprod Biol. 2014;182:123-127. doi:10.1016/j.ejogrb.2014.09.011
 
7.
Vachon-Marceau C, Demers S, Goyet M, Gauthier R, Roberge S, Chaillet N, et al. Labor Dystocia and the Risk of Uterine Rupture in Women with Prior Cesarean. Am J Perinatol. 2016;33(6):577-583. doi:10.1055/s-0035-1570382
 
8.
Kjaergaard H, Olsen J, Ottesen B, Dykes AK. Incidence and outcomes of dystocia in the active phase of labor in term nulliparous women with spontaneous labor onset. Acta Obstet Gynecol Scand. 2009;88(4):402-407. doi:10.1080/00016340902811001
 
9.
Drummond S. Oxytocin Use in Labor: Legal Implications. J Perinat Neonatal Nurs. 2018;32(1):34-42. doi:10.1097/JPN.0000000000000300
 
10.
Bugg GJ, Siddiqui F, Thornton JG. Oxytocin versus no treatment or delayed treatment for slow progress in the first stage of spontaneous labour. Cochrane Database Syst Rev. 2013(6):CD007123. doi:10.1002/14651858.CD007123.pub3
 
11.
Wei S, Wo BL, Qi HP, et al. Early amniotomy and early oxytocin for prevention of, or therapy for, delay in first stage spontaneous labour compared with routine care. Cochrane Database Syst Rev. 2013(8):CD006794. doi:10.1002/14651858.CD006794.pub4
 
12.
Mozurkewich EL, Chilimigras JL, Berman DR, Perni UC, Romero VC, King VJ, et al. Methods of induction of labour: a systematic review. BMC Pregnancy Childbirth. 2011;11(1):84. doi:10.1186/1471-2393-11-84
 
13.
Middleton P, Shepherd E, Flenady V, McBain RD, Crowther CA. Planned early birth versus expectant management (waiting) for prelabour rupture of membranes at term (37 weeks or more). Cochrane Database Syst Rev. 2017(1):166. doi:10.1002/14651858.CD004735.pub4
 
14.
Oladapo OT, Okusanya BO, Abalos E. Intramuscular versus intravenous prophylactic oxytocin for the third stage of labour. Cochrane Database Syst Rev. 2018;9:CD009332. doi:10.1002/14651858.CD009332.pub3
 
15.
Qazi Q, Akhtar Z, Khan K, Khan AH. Woman health: uterus rupture, its complications and management in teaching hospital Bannu, Pakistan. Maedica (Buchar). 2012;7(1):49-53. PMID:23118819.
 
16.
Rousseau A, Burguet A. Oxytocin administration during spontaneous labor: Guidelines for clinical practice. Chapter 5: Maternal risk and adverse effects of using oxytocin augmentation during spontaneous labor. J Gynecol Obstet Hum Reprod. 2017;46(6):509-521. doi:10.1016/j.jogoh.2017.04.012
 
17.
World Health Organization. Sexual and reproductive health: WHO Recommendations for Induction of labour. https://apps.who.int/iris/bits.... Published 2011. Accessed May 15, 2020.
 
18.
Bernitz S, Dalbye R, Zhang J, et al. The frequency of intrapartum caesarean section use with the WHO partograph versus Zhang's guideline in the Labour Progression Study (LaPS): a multicentre, cluster-randomised controlled trial. Lancet. 2019;393(10169):340-348. doi:10.1016/S0140-6736(18)31991-3
 
19.
Simpson KR, James DC. Effects of oxytocin-induced uterine hyperstimulation during labor on fetal oxygen status and fetal heart rate patterns. Am J Obstet Gynecol. 2008;199(1):34e1-34e5. doi:10.1016/j.ajog.2007.12.015
 
20.
Kenyon S, Tokumasu H, Dowswell T, Pledge D, Mori R. High-dose versus low-dose oxytocin for augmentation of delayed labour. Cochrane Database Syst Rev. 2013(7):CD007201. doi:10.1002/14651858.CD007201.pub3
 
21.
Seijmonsbergen-Schermers A, van den Akker T, Beeckman K, Bogaerts A, Barros M, Janssen P, et al. Variations in childbirth interventions in high-income countries: protocol for a multinational cross-sectional study. BMJ Open. 2018;8(1):e017993. doi:10.1136/bmjopen-2017-017993
 
22.
Aziz N, Yousfani S. Analysis of uterine rupture at university teaching hospital Pakistan. Pak J Med Sci. 2015;31(4):920-924. doi:10.12669/pjms.314.7303
 
23.
Amjad A, Amjad U, Zakar R, Usman A, Zakar MZ, Fischer F. Factors associated with caesarean deliveries among child-bearing women in Pakistan: secondary analysis of data from the Demographic and Health Survey, 2012-13. BMC Pregnancy Childbirth. 2018;18(1):113. doi:10.1186/s12884-018-1743-z
 
24.
Bhutta ZA, Hafeez A, Rizvi A, Ali N, Khan A, Ahmad F, et al. Reproductive, maternal, newborn, and child health in Pakistan: challenges and opportunities. Lancet. 2013;381(9884):2207-2218. doi:10.1016/S0140-6736(12)61999-0
 
25.
Atif K, Naqvi SS, Hassan Naqvi SA, Ehsan K, Niazi SA, Javed A. Reproductive health issues in Pakistan; do myths take precedence over medical evidence? J Pak Med Assoc. 2017;67(8):1232-1237. PMID:28839310.
 
26.
de Vries BS, Barratt A, McGeechan K, Tooher J, Wong E, Phipps H, et al. Outcomes of induction of labour in nulliparous women at 38 to 39 weeks pregnancy by clinical indication: An observational study. Aust N Z J Obstet Gynaecol. 2019;59(4):484-492. doi:10.1111/ajo.12930
 
27.
Davey MA, King J. Caesarean section following induction of labour in uncomplicated first births- a population-based cross-sectional analysis of 42,950 births. BMC Pregnancy Childbirth. 2016;16(1):92. doi:10.1186/s12884-016-0869-0
 
28.
Levine LD, Hirshberg A, Srinivas SK. Term induction of labor and risk of cesarean delivery by parity. J Matern Fetal Neonatal Med. 2014;27(12):1232-1236. doi:10.3109/14767058.2013.864274
 
29.
Wood S, Cooper S, Ross S. Does induction of labour increase the risk of caesarean section? A systematic review and meta-analysis of trials in women with intact membranes. BJOG. 2014;121(6):674-685. doi:10.1111/1471-0528.12328
 
30.
Martin JA, Hamilton BE, Osterman MJK, Driscoll AK, Mathews TJ. Births: Final Data for 2015. In: National Vital Statistics Reports. https://www.cdc.gov/nchs/data/.... Published January 5, 2017. Accessed May 15, 2020.
 
31.
National Health Service. NHS Maternity Statistics, England 2017-18. https://digital.nhs.uk/data-an.... Published October 25, 2018. Accessed May 15, 2020.
 
32.
Rossen J, Ostborg TB, Lindtjorn E, Schulz J, Eggebo TM. Judicious use of oxytocin augmentation for the management of prolonged labor. Acta Obstet Gynecol Scand. 2016;95(3):355-361. doi:10.1111/aogs.12821
 
33.
de Jonge A, Peters L, Geerts CC, van Roosmalen JJM, Twisk JWR, Brocklehurst P, et al. Mode of birth and medical interventions among women at low risk of complications: A cross-national comparison of birth settings in England and the Netherlands. PLoS One. 2017;12(7):e0180846. doi:10.1371/journal.pone.0180846
 
34.
Gaudernack LC, Froslie KF, Michelsen TM, Voldner N, Lukasse M. De-medicalization of birth by reducing the use of oxytocin for augmentation among first-time mothers - a prospective intervention study. BMC Pregnancy Childbirth. 2018;18(1):76. doi:10.1186/s12884-018-1706-4
 
35.
Clesse C, Lighezzolo-Alnot J, De Lavergne S, Hamlin S, Scheffler M. Statistical trends of episiotomy around the world: Comparative systematic review of changing practices. Health Care Women Int. 2018;39(6):644-662. doi:10.1080/07399332.2018.1445253
 
36.
Jiang H, Qian X, Carroli G, Garner P. Selective versus routine use of episiotomy for vaginal birth. Cochrane Database Syst Rev. 2017;2:CD000081. doi:10.1002/14651858.CD000081
 
37.
Harrison MS, Saleem S, Ali S, et al. A Prospective, Population-Based Study of Trends in Operative Vaginal Delivery Compared to Cesarean Delivery Rates in Low- and Middle-Income Countries, 2010-2016. Am J Perinatol. 2018;12(S2). doi:10.1186/1742-4755-12-S2-S9
 
38.
Merriam AA, Ananth CV, Wright JD, Siddiq Z, D'Alton ME, Friedman AM. Trends in operative vaginal delivery, 2005-2013: a population-based study. BJOG. 2017;124(9):1365-1372. doi:10.1111/1471-0528.14553
 
39.
Hehir MP. Trends in vaginal breech delivery. J Epidemiol Community Health. 2015;69(12):1237-1239. doi:10.1136/jech-2015-205592
 
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