丹麦兰德斯地区医院Sidsel Boie团队比较了产程活跃期催产素持续刺激与终止刺激对剖宫产率的影响。2021年4月14日，该研究发表在《英国医学杂志》上。

为了确定在产程活跃期停止催产素刺激是否与较低的剖腹产率有关，2016年4月8日至2020年6月30日，研究组在丹麦的9家医院、荷兰的1家医院进行了一项国际多中心、双盲、随机对照试验。1200名女性在分娩潜伏期静脉注射催产素，将其随机分组，其中607名在分娩活跃期停止催产素刺激，593名继续输注催产素刺激。主要观察指标为剖腹产分娩。

中止组的剖宫产率为16.6%（n=101），继续组的剖宫产率为14.2%（n=84），相对风险比为1.17。在94例既往无剖宫产史的产妇中，停药组剖宫产率为7.5%，继续组剖宫产率为0.6%，相对风险比为11.6。与继续组相比，中止组女性分娩时间较长，过度刺激的风险降低，胎儿心率异常风险降低，但两组间其他不良孕产妇和新生儿结局的发生率相似。

研究结果表明，在可以保证监测胎儿状况和子宫收缩的情况下，常规停止催产素刺激可导致剖宫产率的小幅增加，但显著降低了子宫过度刺激和异常胎心率模式的风险。

附：英文原文

Title: Continued versus discontinued oxytocin stimulation in the active phase of labour (CONDISOX): double blind randomised controlled trial

Author: Sidsel Boie, Julie Glavind, Niels Uldbjerg, Philip J Steer, Pinar Bor

Issue&Volume: 2021/04/14

Abstract:

Objective To determine whether discontinuing oxytocin stimulation in the active phase of induced labour is associated with lower caesarean section rates.

Design International multicentre, double blind, randomised controlled trial.

Setting Nine hospitals in Denmark and one in the Netherlands between 8 April 2016 and 30 June 2020.

Participants 1200 women stimulated with intravenous oxytocin infusion during the latent phase of induced labour.

Intervention Women were randomly assigned to have their oxytocin stimulation discontinued or continued in the active phase of labour.

Main outcome measure Delivery by caesarean section.

Results A total of 607 women were assigned to discontinuation and 593 to continuation of the oxytocin infusion. The rates of caesarean section were 16.6% (n=101) in the discontinued group and 14.2% (n=84) in the continued group (relative risk 1.17, 95% confidence interval 0.90 to 1.53). In 94 parous women with no previous caesarean section, the caesarean section rate was 7.5% (11/147) in the discontinued group and 0.6% (1/155)in the continued group (relative risk 11.6, 1.15 to 88.7). Discontinuation was associated with longer duration of labour (median from randomisation to delivery 282 v 201 min; P<0.001), a reduced risk of hyperstimulation (20/546 (3.7%) v 70/541 (12.9%); P<0.001), and a reduced risk of fetal heart rate abnormalities (153/548 (27.9%) v 219/537 (40.8%); P<0.001) but rates of other adverse maternal and neonatal outcomes were similar between groups.

Conclusions In a setting where monitoring of the fetal condition and the uterine contractions can be guaranteed, routine discontinuation of oxytocin stimulation may lead to a small increase in caesarean section rate but a significantly reduced risk of uterine hyperstimulation and abnormal fetal heart rate patterns.

DOI: 10.1136/bmj.n716

Source: https://www.bmj.com/content/373/bmj.n716