Recommandations pour l’administration d’oxytocine au cours du travail spontané. Chapitre 4 : efficacité de l’oxytocine au cours du travail spontané selon les modalités d’administration

[Normal childbirth: Physiologic labor support and medical procedures. Guidelines of the French National Authority for Health (HAS) with the collaboration of the French College of Gynaecologists and Obstetricians (CNGOF) and the French College of Midwives (CNSF) - Initial assessment on admission and fetal monitoring during labor]

OBJECTIVES

The purpose of this literature's review is to provide recommendations for measures to assess fetal "well-being" at admission and during labor in order to identify a non-reassuring fetal condition.

METHODS

Consultation of the Medline database, and of national and international guidelines.

RESULTS

Two fetal heart rate monitoring techniques are available at admission and during labor. In comparison with intermittent auscultation (AI), continuous cardiotocography (CTG) monitoring was associated, in a meta-analysis involving 13 trials including more than 37,000 women, with a reduction in RR neonatal seizures by half. Relative risk (RR)=0.50 with a 95% CI [0.31-0.80] without significant difference objectified with respect to cerebral palsy RR=1.75 95% CI [0.84-3.63]. In contrast, a significant increase in cesarean sections was associated with continuous CTG RR=1.63 95% CI [1.29-2.07] and women were also at greater risk for operative vaginal delivery RR=1.15 95% CI [1.01-1.33]. Current results are insufficient to demonstrate the actual impact of surveillance methods (continuous or discontinuous) on the overall perinatal mortality rate. Larger randomized trials remain to be conducted.

CONCLUSION

The systematic search for the confirmation of the reassuring character of the fetal state at admission and during labor makes it possible to identify intrapartum hypoxic events.