AFJOG

African Journal of Obstetrics and Gynaecology | Volume 3 | Issue 2 | 2025 | 24 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 Mean 3212.1 3048.9 3418.9 3156.9 0.693 (SD) (432.9) (422.9) 0.170 (424.1) (394.8) DISCUSSION This study compared birth outcomes between primigravid women who received accelerated-dose oxytocin augmentation (starting at a higher dose, reaching maximumwithin 1.5 hours) versus gradual-dose augmentation (starting lower, reaching maximum within 3 hours). Despite oxytocin use, only 36.5% achieved vaginal delivery overall, with no significant difference between the regimens. However, the accelerated dose regimen was associated with a shorter time-to-delivery interval. More women received Pethidine, suggesting increased need for analgesia when oxytocin is used at a higher rate. C-section rates were higher in women with increased BMI. Birth weights were lower at the center using the accelerated regimen, however, the mean birth weights were was comparable vaginal versus c-section delivery modes. The primigravid women were young, with increased body weight and delivered at similar term gestations in both hospitals. This aligns with a recent national report by Stats SA (2022) showing the median age of mothers was 28.2 years, and 70% of births in 2022 were attributed to mothers aged 20–34 years. The highest birth rates were among mothers aged 17 or younger occurring in KwaZulu-Natal, followed by Eastern Cape, and Limpopo 14 . Our women were younger than reported in other African studies which had higher percentages of older (mean ages 27- 28 years) primigravid women 15-17 . The younger age observed in this study population may be attributed to the focus on oxytocin-augmented primigravidae, and not a broader primigravid cohort. Similar to our findings, these studies also observed a significant proportion of women with elevated BMIs above 25 kg/m2 (being overweight or obese). These findings are consistent with the reported high rates of overweight and obesity among African women of reproductive age 18 . Oxytocin augmentation in this study failed to facilitate vaginal delivery in the majority of cases, resulting in a high C-section rate of 63%. This rate is higher than the recorded C-section rates at both hospitals, which include women of higher parity and those without augmentation. From labour ward records (unpublished data), the average C-section rate among primigravid women is 46%, with the most common indications being foetal compromise and poor progress of labour. Hidalgo- Lopezosa et al., reported that augmentation of labour with oxytocin is associated with increased C-section rates, a higher percentage of intrapartum fever, lower umbilical cord pH, and increased need for advanced newborn resuscitation 19 . The vaginal delivery rate in the current study was much lower (36.5%) than expected, regardless of the oxytocin titration rate. Bugg et al., found a successful vaginal delivery rate of 51.1% among nulliparous women who received oxytocin augmentation 20 . Several factors may have contributed to the low vaginal delivery rate observed. Firstly, the diagnosis of foetal distress in 33-50% of cases based on cardiotocograph findings, which may have been erroneous. Additionally, most C-sections were performed due to poor progress, encompassing both cephalopelvic disproportion and labour dystocia, the latter of which may be underrepresented by our data. Our study showed a significantly reduced interval from augmentation commencement to delivery with the accelerated dose regimen, for both vaginal and C-section deliveries. This finding aligns with previous research showing that high-dose oxytocin regimens significantly reduce labour duration 4,12,21 . The primary goal of augmentation is to shorten the duration of labour, preventing maternal fatigue, pain, and anxiety. Anxiety and fatigue are associated with dysfunctional uterine contractility, secondary arrest of cervical dilation, and disorders of the active phase, ultimately affecting birth outcomes 22 . The reduced labour duration has practical benefits, including decreased maternal fatigue, reduced infection risk from prolonged labour, and more efficient use of healthcare resources. Interestingly, we observed higher pethidine use as analgesia with the accelerated dose regimen. This could reflect increased pain perception by patients or a more compassionate approach by practitioners. Pethidine was administered to nearly all women receiving the accelerated dose regimen, likely reflecting local hospital practice. This contrasts with its selective use in the other facility. Studies have shown that accelerated oxytocin regimens increase the risk of uterine hyperstimulation 1,10 . The widespread use of pethidine in the high-dose group highlights the importance of adequate pain management during labour, particularlywithhigher oxytocindoses. Augmentation generally increases the need for analgesics and epidural analgesia. The latter has been associated with improved uterine coordination and pain reduction 23 . Although hyperstimulation is associated with foetal asphyxia and can negatively impact foetal outcomes, this study found no correlation between hyperstimulation and poor neonatal outcomes, including Apgar scores. This aligns with findings of Bidgood and Steer 24 , which compared three groups (control, 2 mU/min starting dose, and 7 mU/min starting dose) and found no measurable differences in the condition of neonates. Neonates delivered vaginally had slightly lower mean birthweights compared to those born via C-section in both the accelerated and gradual dose groups. Interestingly, babies born at the gradual dose center were heavier than those at the accelerated dose center, aligning with the higher mean maternal BMI. However, this difference was not statistically significant. Gaudet et al., confirmed that maternal obesity is associated with foetal overgrowth 25 . The World Health Organization (WHO) defines macrosomia as birthweight equal toor greater than4000gor 4500g. Despite the higher birth weight of neonates born via C-section in the gradual-dose regimen, mean birth weights from both regimens were within the ‘normal birth weight’ range. Consequently, we cannot draw inferences about the association between oxytocin dose and mean birthweight in neonates, as all were considered to have normal birth weights. Limitations of the study: This study had several limitations, primarily due to its reliance on retrospective data and record-keeping quality. Both institutions experienced challenges with missing documentation, incomplete information, and absent records