الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Background: Prolonged labour is most common among nulliparous women and is related to increased pain and negative experiences. It is also frequently associated with fetal distress and is one of the main indications for an emergency caesarean section. Caesarean section accounts for nearly one quarter of births in England and Wales and the most common cause accounting for 30% of caesarean births is failure to progress or dystocia. Nulliparous women delivering vaginally found it taking an average 5.5 hours to dilate from 4-10 cm. Women who had not yet reached 7 cm dilatation often had no cervical change for more than 2 hours or fetal descent in the second stage of labour also appear to take longer. Oxytocin augmentation of uterine contractions is widely used to treat slow labour, although the exact timing of initiation varies widely. The World Health Organization recommends the use of a partogram with an alert line indicating normal progress, defined as a cervical dilatation of 1 cm/hour and an action line 4 hours to the right to detect and treat prolonged labour. Active management of labour includes early amniotomy, oxytocin augmentation when the progress of labour deviates form the alert line and personal support to the labouring woman. Objectives: The aim of our work was to study the effect of early versus delayed oxytocin augmentation on the obstetrical and neonatal outcomes in nulliparous women with spontaneous but prolonged labour.
Patients and methods: A randomized controlled study was conducted at the Delivery Unit of Obstetrics and Gynecolgy Department, Zagazig University Hospitals during the period form February 2011 till November 2011. Healthy nulliparous women with normal pregnancy of singletone fetus, cephalic presentation, gestational age of 37-41 weeks, spontaneous onset of labour and cervical dilatation (4-9 cm) were included in the study. Pregnant females with any of the following: chronic maternal disease (hypertension, diabetes mellitus, cardiac diseases, renal diseases, etc…), non-cephalic presentation (breech, transverse lie, oblique lie, etc…), Intrauterine Fetal Death (IUFD), multiple pregnancies (twins, triples, etc…) or prelabour rupture of membranes were excluded from the study. All women that fulfilled the inclusion criteria were further subdivided into two groups: Group 1: 250 pregnant nulliparous women undergoing early oxytocin administration in augmentation of labour (within 20 minutes from randomization in the study). Group 2: 250 pregnant nulliparous women undergoing late oxytocin administration in augmentation of labour. Results: The results of the study showed absence of any clear difference between the early and the late use of oxytiocin as regard caesarean section rate, Apgar score below 7 after 5 minutes of delivery and number of neonates when transferred to neonatal ICU) nor sphincter laceration. Also, there was a significant difference between the early and the late oxytocin groups in the duration of labour which was shorter by 84 minutes in the early-oxytocin group than the late-oxytocin group. There were no significant differences between the early and the late oxytocin groups as regard the CS rate, assisted vagianl deliveries, sphincteric lacerations or neonatal outcomes.
Conclusion: There were no significant differences between early versus late administration of oxytocin augmentation in nulliparous women with slow labour in relation to the mode of delivery, sphincteric lacerations and neonatal outcomes. Only the interval from randomization to delivery was significantly shorter in the early oxytocin gropu than the late oxytocin group.