Abstract | OBJECTIVE: STUDY DESIGN: A nested case-control study was conducted within a multicenter, retrospective cohort study of more than 25,000 women with at least 1 prior cesarean delivery, comparing cases of uterine rupture with controls (no rupture) while attempting VBAC. Time-to-event analyses were performed to examine the effect of maximum oxytocin dose on the risk of uterine rupture considering therapy duration, while adjusting for confounders. RESULTS: Within the nested case-control study of 804 patients, 272 were exposed to oxytocin: 62 cases of uterine rupture and 210 controls. Maximum oxytocin ranges above 20 mU/min increased the risk of uterine rupture 4-fold or greater (21-30 mU/min: hazard ratio [HR] 3.92, 95% confidence interval [CI], 1.06 to 14.52; 31-40 mU/min: HR 4.57, 95% CI, 1.00 to 20.82). CONCLUSION: These findings support a maximum oxytocin dose of 20 mU/min in VBAC trials to avoid an unacceptably high risk of uterine rupture.
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Authors | Alison G Cahill, Brian M Waterman, David M Stamilio, Anthony O Odibo, Jenifer E Allsworth, Bradley Evanoff, George A Macones |
Journal | American journal of obstetrics and gynecology
(Am J Obstet Gynecol)
Vol. 199
Issue 1
Pg. 32.e1-5
(Jul 2008)
ISSN: 1097-6868 [Electronic] United States |
PMID | 18455132
(Publication Type: Comparative Study, Journal Article, Multicenter Study, Research Support, N.I.H., Extramural)
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Chemical References |
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Topics |
- Adult
- Case-Control Studies
- Dose-Response Relationship, Drug
- Female
- Humans
- Oxytocics
(administration & dosage, adverse effects)
- Oxytocin
(administration & dosage, adverse effects)
- Retrospective Studies
- Risk Assessment
- Risk Factors
- Time Factors
- Uterine Rupture
(epidemiology, etiology)
- Vaginal Birth after Cesarean
(adverse effects)
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