AFJOG

African Journal of Obstetrics and Gynaecology | Volume 3 | Issue 2 | 2025 | 21 ORIGINAL RESEARCH African Journal of Obstetrics and Gynaecology | Volume 3 | Issue 2 | 2025 | Birth outcomes of primigravid women augmented with oxytocin in two regional hospitals: A comparison of gradual vs accelerated regimen ABSTRACT Background: Oxytocin augmentation is commonly used to manage slow labour progress, particularly in primigravid women. However, the optimal dosing regimen for achieving safe and successful vaginal delivery remains unclear. This study aims to address the knowledge gap regarding the effectiveness and safety of oxytocin augmentation regimens in our local context. Objectives: To compare the effectiveness and safety of gradual versus accelerated oxytocin increment regimens for augmenting labour in primigravid women at two regional hospitals. Methods: A retrospective case review was conducted on primigravid women undergoing labour augmentation at Harry Gwala Regional Hospital (HGRH) and RK Khan (RKK) Hospital in KwaZulu-Natal, South Africa, from March to August 2022. The accelerated regimen started at 5mU/min, while the gradual regimen started at 2mU/min. Both reached a maximum dose of 20mU/minute, with the accelerated dose reaching this within 1.5 hours and the gradual dose within 3 hours. Results: The study compared 56 patients receiving the accelerated regimen at RKK with 40 patients receiving the gradual regimen at HGRH. Overall vaginal delivery rate was 36.5% (35/96), with no significant difference between the accelerated (39.3%, 22/56) and gradual (32.5%, 13/40) groups (p = 0.464). Caesarean section rates were 60.7% (34/56) for the accelerated regimen and 67.5% (27/40) for the gradual regimen. The accelerated regimen significantly reduced labour duration (2.88 hours vs 5 hours, p < 0.001). Maternal and foetal characteristics were comparable between groups, except for higher maternal obesity rates in the gradual dose group (p = 0.022). No significant differences were observed in maternal complications or neonatal outcomes between the two groups. Conclusion: The accelerated oxytocin regimen significantly shortened labour duration without compromising maternal or neonatal outcomes. However, both regimens failed to achieve vaginal delivery in over 60% of primigravidae, highlighting the need for further research to optimize oxytocin augmentation strategies. Keywords: primigravida, augmentation dose, oxytocin, vaginal delivery, caesarean section delivery, birth outcomes BACKGROUND The increasing rates of caesarean deliveries is a growing concern in obstetrics, as studies suggest caesarean sections (C-sections) can lead to higher maternal and neonatal morbidities 1,2 . Although lifesaving, C-sections carry risks such as respiratory deficiencies in infants, maternal haemorrhage, and future pregnancy complications like uterine rupture and abnormal placental implantation 3 . One of the main reasons for rising C-section rates is labour dystocia 4-6 , defined as failure of the cervix to dilate due to insufficient uterine contractions, occipito-posterior position of the foetus, and cephalo-pelvic disproportion 5 . Medical interventions for dystocia include amniotomy if the membranes are still intact and oxytocin augmentation 1 . Oxytocin is a hormone produced by the hypothalamus and released by the posterior pituitary gland 7 , which increases uterine contractions during labour and milk ejection 8 . While oxytocin is widely used to shorten labour and achieve normal vaginal delivery, high a dose can lead to foetal asphyxia, uterine hyperstimulation, episiotomy and water intoxication 9 . Maternal factors such as weight, parity, cervical favourability, and prior mode of delivery as well as foetal factors such as weight and gestational age can influence the efficacy of oxytocin augmentation 10 . Parity is the most important factor as women are more sensitive to stimulants after having a child 11 . The optimal dosage, safety, and efficacy of oxytocin use remains controversial. Some studies have shown that a higher-dose oxytocin regimens (>4mU/min) improves vaginal delivery rates with no increase in complications 4,9 , whileothers reportedhigher rates of uterinehyperstimulation with higher doses 12 . Conversely, a study by Lazor et al., found no change in C-section rates or labour duration with higher-dose oxytocin 13 . Despite the widespread use of oxytocin for labour augmentation, there is a lack of consensus on the optimal dosing regimen. This study aimed to compare the efficacy and safety of a gradual versus accelerated increment of oxytocin in primigravid labouring women. METHODS Study design and setting This retrospective case review was conducted in two regional hospitals in KwaZulu-Natal, South Africa: Harry Gwala Regional Hospital (HGRH, formerly Edendale) and RK Khan (RKK) Hospital. The population characteristics were expected to be similar for both institutions. Both hospitals serve high and low-risk patients due to limited midwife-operated units (MOU) in their areas. HGRH has a 44% C-section rate, while RKK's rate is 50%. The most common indications for emergency C-sections at both hospitals are poor progress and foetal compromise. The two hospitals use different protocols to augment labour in primigravidae with poor progress. RKK Hospital uses an B Nonkula 1 , MA Hlabisa, HM Sebitloane 1 1 Department of Obstetrics and Gynaecology, School of Clinical Medicine, University of KwaZulu Natal, Durban, South Africa CORRESPONDENCE: HM Sebitloane | Email: Sebitloanem@ukzn.ac.za Birth outcomes of primigravid women augmented with oxytocin in two regional hospitals: A comparison of gradual vs accelerated regimen