INDUCTION OF LABOR WITH PULSATILE OXYTOCIN BY A COMPUTER-CONTROLLED PUMP

OBJECTIVE: The objective was to test the safety and efficacy of a puls atile oxytocin infusion protocol in which a computer-controlled pump a djusts the oxytocin dose rate on the basis of uterine activity. STUDY DESIGN: A total of 358 women were enrolled in, and 310 completed, a pr ospective, randomized clinical trial comparing three protocols for the induction of labor with oxytocin: aggressively managed continuous inf usion, conservatively managed continuous infusion, and computer-contro lled pulsatile infusion. Results were analyzed with Student t and chi( 2) ''goodness-of-fit'' tests. RESULTS: Mean doses of oxytocin in the g roup receiving pulsed oxytocin were approximately 20% of the dose rate s in the continuous infusion protocols. All protocols effectively esta blished labor in the majority of patients, although nulliparous women with unfavorable Bishop scores were more likely to fail to establish l abor within a 24-hour period when treated with the aggressive continuo us protocol. There were no differences in the rates of cesarean sectio n, hyperstimulation, blood gases, or Apgar scores among the three trea tment groups. CONCLUSIONS: Oxytocin dosage was minimized by use of a c omputer-controlled pump. With the exception of aggressively managed nu lliparous women, there were no differences in the percentages of patie nts with successful inductions among the three protocols. The percenta ge of successful inductions was lower for aggressively managed nullipa rous women than for other patient and protocol groups.