AFJOG

African Journal of Obstetrics and Gynaecology | Volume 3 | Issue 2 | 2025 | 22 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 ‘accelerated’ oxytocin increment, starting with 5 IU oxytocin in 1 L Modified Ringer’s Lactate at 60 mL/hr (5 mU/min), titrating half-hourly to a maximum of 240 mL/hr (20 mU/ min) within 1.5 hours (Table 1). Contractions are palpated 20-30 minutes after infusion start, and the rate is sustained unless contraindicated. In contrast, HGRH employs a ‘gradual’ oxytocin increment, beginning with 10 IU oxytocin in 1 L Modified Ringer’s Lactate at 12 mL/hr (2 mU/min), titrating half-hourly to a maximum of 120 mL/hr (20 mU/min) within 3 hours (Table 1). The aim is to achieve 3 strong contractions (lasting longer than 40 seconds) per 10 minutes. For this study, the 2 mU/min starting dose was considered gradual, while the 5 mU/min starting dose was considered accelerated, based on the time taken to reach the maximum dose. Table 1: Oxytocin regimens at RKK (accelerated) and HGRH (gradual) Time Intervals Initial 30 minutes 1 hour 1 hour 30 minutes 2 hours 2 hours 30 minutes 3 hours Accelerated increments (mU/ minutes) 5 10 20 - - - Gradual increments (mU/ minutes) 2 4 8 10 16 20 Participants The study participants were selected based on specific inclusion and exclusion criteria. Eligible recordswere those of primigravid women who received oxytocin for augmentation following spontaneous labour, with or without amniotomy performed. The study excluded multiparous women, those with previous caesarean sections, women diagnosed with cephalo-pelvic disproportion, patients in the latent phase of labour, cases of foetal malposition or malpresentation, and patients who had induction of labour. Data collection Patient files meeting the inclusion criteria were collected from the maternity wards of both hospitals over a six-month period (March to August 2022). Relevant data was extracted and entered into a study data extraction form, maintaining patient anonymity. The form captured demographics, clinical information, and findings, including age, weight, height, parity, gestational age, oxytocin dosage, mode of delivery, possible labour complications, and neonatal outcomes. Statistical analysis Based on the delivery rates of over 500 per month at each regional hospital, with at least 20% being primigravidae, it was estimated that approximately 600 primigravid women would deliver over a 6-month period. Assuming an average C-section rate of 45%, we anticipated assessing 330 labouring primigravid women. However, due to unavailable data on labour augmentation frequency, all available records over a 6-month period in each hospital were analysed. Data was entered into Microsoft Excel and analysed using Stata version 15. Descriptive statistics, including frequencies and percentages, were used to summarise categorical variables. For normally distributed variables, means and standard deviations were used to measure central tendency and dispersion. For skewed variables, medians and interquartile ranges were used. Participants who received the accelerated regimen versus those who received the gradual regimen were compared. The unpaired t-test was used to assess differences in means for maternal age, body mass index (BMI), gestational age at delivery, cervical dilatation at augmentation onset, maximum oxytocin dose, interval from augmentation commencement to delivery, neonatal birthweight, and APGAR scores. The hypothesis test was used to determine differences in proportions for successful vaginal delivery, caesarean section rates, and Pethidine use. Ethical considerations Ethical approval was obtained from the Biomedical Research Ethics Committee (BREC) of the University of KwaZulu- Natal (BREC/000003435/2021). Further approval was obtained from hospital management of R.K Khan and Harry Gwala Hospital, as well as Provincial Department of Health (KZ_202204_021). Patient consent was not required. RESULTS In 2022, RKK Hospital had an average of 607 monthly deliveries, totalling 7 286 for the year, with 1 621 primigravidae. Between March and August 2022, 650 primigravid patients delivered at RKK Hospital, of which 597 files were analysed. Only 67 patients were augmented, 11 were excluded due to not meeting inclusion criteria, resulting in 56 study enrolments (Figure 1). HGRH recorded 8 297 total births in 2022, with a C-section rate between 43.4% and 46.9%. From March to August 2022, 1 043 primigravid patients delivered at HGRH, with 872 files available for analysis. Of these, 73 patients were augmented, 33 were excluded due to incomplete augmentation details. A total of 40 participants were then enrolled in the study (Figure 1). Figure 1: Flow diagram comparing the patients at RKK and HGR Hospitals 597 Files retrieved. 71 Augmented 11 excluded • Latent phase of labour (8) • Had IOL (3) 526 Not Augmented 56 enrolled in the study 34 CS (60,7%) 22 NVD (39,3%) RKK