Oxytocin Regimen for Labor Augmentation, Labor Progression, and Perinatal Outcomes

摘要

In Reply: We appreciate Dr. Ferrazzi and colleagues' interest in our study. They raised a valid point that, given the wide individual variability of response to oxytocin, the increment and maximum doses may differ among women who were assigned to the same oxytocin regimen. Total amount of oxytocin also is likely to have substantial overlap among the groups of various oxytocin protocols. However, the real clinical question to a physician is which regimen (low or high) he or she should choose when oxytocin is needed without considering the variability in the response that would affect subsequent titration. In our study, the selection of starting dose (ie, the low and high regimens) was by and large based on provider preference rather than uterine activity. Thus, one practical approach to study this very complex issue in an observational study is to stratify the groups based on the starting dose and control for other baseline characteristics, similar to "intent-to-treat." Our data showed that low-regimen groups had lower starting, increment, and highest doses received (Table 1 in our article). Therefore, our conclusion is valid.