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The following is a summary of “Reduced risk of cesarean delivery with oxytocin discontinuation in active labor: a systematic review and meta-analysis,” published in the March 2025 issue of American Journal of Obstetrics & Gynecology by WHITLEY et al. 

Researchers conducted a retrospective study to estimate whether discontinuing oxytocin during the active phase of labor affected cesarean delivery (CD) rates compared to its continuation.  

They included randomized controlled trials (RCTs) of pregnant individuals who acquired oxytocin for labor induction or augmentation, comparing its discontinuation vs continuation in active labor (as defined by each trial). The primary outcome was the rate of CD, while secondary maternal outcomes included postpartum hemorrhage, total blood loss, and infections. Neonatal outcomes assessed were Apgar score at 5 minutes <7, umbilical arterial pH <7.10, neonatal therapeutic hypothermia, NICU admission, resuscitation at birth, and neonatal death. The risk of bias was evaluated per the Cochrane Handbook for Systematic Reviews of Interventions, and heterogeneity was assessed using Higgins I². Meta-analysis was conducted in Review Manager 5.4.1 and StataSE 16 to estimate RR or mean differences with 95% confidence intervals (CIs). Trustworthiness of included trials was assessed per the OBGYN Editors’ Integrity Group criteria, and a leave-one-out analysis was conducted to investigate the influence of studies with trustworthiness concerns.  

The results showed that 15 RCTs with 5,734 individuals were included in the meta-analysis. The rate of CD, analyzed in 13 studies, was lower with oxytocin discontinuation in active labor (RR=0.80; 95% CI, 0.66-0.97; 95% prediction interval, 0.38-1.22). Discontinuation was also linked to a reduced risk of uterine tachysystole (RR=0.45; 95% CI, 0.34-0.60; I², 26%) and non-reassuring fetal heart rate tracing (RR=0.64; 95% CI, 0.49-0.82; I², 41%). However, discontinuation prolonged active labor by approximately 30 minutes and the second stage of labor by around 6 minutes.  

Investigators concluded that discontinuing oxytocin during active labor, despite slightly prolonging labor, potentially reduced CD rates and adverse fetal and uterine events. 

Source: ajog.org/article/S0002-9378(25)00161-9/fulltext