Start of induction of labour with oxytocin in the morning or in the evening. A randomised controlled trial

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Abstract
Objective  The objective of this study was to compare outcomes of induced labour with intravenous oxytocin with a start in the evening versus in the morning.Design  Randomised controlled trial.Setting  Labour wards of three hospitals in Amsterdam, the Netherlands.Participants  Women with an indication for induction of labour with intravenous oxytocin.Methods  Included women were randomized to either the evening group with a start of induction of labour at 21:00 hours, or the morning group with a start at 07:00 hours.Main outcome measures  Primary outcome was duration of labour. Secondary outcomes were instrumental delivery rate, adverse neonatal outcome defined as an Apgar score below 7 after 5 minutes, number and indications of paediatric consults and neonatal admissions, duration of second stage, number of intrapartum infections and necessity of pain relief.Results  We randomised 371 women. Mean duration of labour was not significantly different (primiparae: morning 12 hours and 8 minutes versus evening 11 hours and 22 minutes, P value 0.29; multiparae: morning 7 hours and 34 minutes versus evening 7 hours and 46 minutes, P value 0.70). There were no significant differences in instrumental deliveries rates, number of infections or patient satisfaction. Unexpectedly, neonatal outcome was better in women induced in the evening.Conclusion  Induction of labour with intravenous oxytocin in the evening is equally effective as induction in the morning.