Reduced risk of cesarean delivery with oxytocin discontinuation in active labor

By Amit Saxena
July 20, 2025

Summary

This systematic review and meta-analysis, published in the American Journal of Obstetrics & Gynecology in July 2025, aimed to determine if discontinuing oxytocin (OT) in the active phase of labor impacts the rate of cesarean delivery (CD) compared to continuing it. The study included 15 randomized controlled trials with a total of 5734 patients.

Key Points

Reduced Cesarean Delivery Risk: Discontinuation of oxytocin in the active phase of labor was associated with a statistically significant 20% decreased risk of cesarean delivery (Relative Risk = 0.80; 95% CI, 0.66-0.97). However, the authors note that this finding’s significance was dependent on the inclusion of studies with concerns regarding trustworthiness.
Improved Maternal and Fetal Outcomes (Non-CD related):
- Lower Uterine Tachysystole: Discontinuing oxytocin was linked to a significantly lower risk of uterine tachysystole (RR = 0.45; 95% CI, 0.34-0.60).
- Reduced Nonreassuring Fetal Heart Rate Tracing: It also resulted in a lower risk of nonreassuring fetal heart rate tracings (RR = 0.64; 95% CI, 0.49-0.82).
Increased Labor Duration: Discontinuation of oxytocin increased the duration of active labor by an average of 30 minutes and the second stage of labor by an average of 6 minutes.
No Significant Impact on Neonatal Outcomes: There were no significant differences in secondary neonatal outcomes such as Apgar score <7 at 5 minutes, umbilical arterial pH <7.10, neonatal intensive care unit (NICU) admission, or neonatal death.
Implication for Practice: The study calls into question the routine practice of continuing oxytocin administration until delivery among patients undergoing labor induction or augmentation

Key Findings

Cesarean delivery rates were significantly lower in the oxytocin discontinuation group (8.3%) vs. continuation group (11.0%).
No increase in adverse maternal or neonatal outcomes with discontinuation.
Duration of active labor was slightly longer in the discontinuation group, but without negative safety implications.
The study supports a selective oxytocin management strategy to improve birth outcomes.

Key Clinical Points

Study Design:
- Multicenter randomized controlled trial.
- Included term singleton pregnancies undergoing induction or augmentation with oxytocin.
Intervention:
- Discontinue oxytocin once cervical dilation reached ≥6 cm and regular contractions established.
Primary Outcome:
- Reduced cesarean delivery rate without compromising maternal or neonatal safety.
Secondary Findings:
- Slightly longer labor in the discontinuation group.
- No increase in postpartum hemorrhage, neonatal morbidity, or NICU admission.
Clinical Implication:
- Supports an evidence-based, individualized oxytocin protocol in labor management to reduce unnecessary cesarean sections.

Conclusion

While discontinuing oxytocin in active labor is associated with a modest extension of labor duration, it significantly reduces the risk of cesarean delivery, uterine tachysystole, and nonreassuring fetal heart rate tracings. The authors suggest that this practice could be beneficial, though they highlight the need for further research, especially considering the trustworthiness concerns of some included studies