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Objective To investigate whether the use of intrauterine tocodynamometry versus external tocodynamometry (IT versus ET) during labour reduces operative deliveries and improves newborn outcome. As IT provides more accurate information on labour contractions, the hypothesis was that it may more appropriately guide oxytocin use than ET. Design Randomised controlled trial. Setting Two labour wards, in a university tertiary hospital and a central hospital. Population A total of 1504 parturients with singleton pregnancies, gestational age ≥37 weeks and fetus in cephalic position: 269 women with uterine scars, 889 nulliparas and 346 parous women with oxytocin augmentation. Methods Participants underwent IT (n = 736) or ET (n = 768) during the active first stage of labour. Main outcome measures Primary outcome: rate of operative deliveries. Secondary outcomes duration of labour, amount of oxytocin given, adverse neonatal outcomes. Results Operative delivery rates were 26.9% (IT) and 25.9% (ET) (odds ratio 1.05, 95% CI 0.84-1.32, P = 0.663). The ET to IT conversion rate was 31%. We found no differences in secondary outcomes (IT versus ET). IT reduced oxytocin use during labours with signs of fetal distress, and trial of labour after caesarean section. Conclusions IT did not reduce the rate of operative deliveries, use of oxytocin, or adverse neonatal outcomes, and it did not shorten labour duration. Tweetable abstract IT (versus ET) reduced oxytocin use in high-risk labours but did not influence operative delivery rate or adverse neonatal outcomes.

Objective. To compare the neonatal outcome between planned vaginal or planned cesarean section (CS) breech delivery and planned vaginal vertex delivery at term with singleton fetuses. Design. A cohort study. Setting. Delivery Unit, Tampere University Hospital, Finland, with 5200 annual deliveries. Population. The term breech deliveries over a period of five years (January 2004 to January 2009), a total of 751 breech deliveries, and 257 vertex controls. Methods. The data were collected from the mother's medical records, including a summary of the newborn. In the case of neonatal health problems, the pediatric records were also examined. Main outcome measures. Maternal and neonatal mortality and morbidity as defined in the Term Breech Trial. Low Apgar scores or umbilical cord pH as secondary end-points. Results. There was no neonatal mortality. Severe morbidity was rare in all groups, with no differences between groups. The Apgar scores at one minute were lower in the planned vaginal delivery group compared with the other groups, but there was no difference at the age of five minutes. Significantly more infants in the vaginal delivery group had a cord pH < 7.05. There was one maternal death due to a complicated CS in the planned CS group and none in the other groups. Mothers in the planned CS group suffered significantly more often from massive bleeding and needed transfusions. Conclusions. Vaginal delivery remains an acceptable option for breech delivery in selected cases.

Arrested labor secondary to dystocia remains a major indication for acute cesarean section (CS) in many parts of the world. Apart from anatomic problems and malpresentation, the major culprit is uterine dysfunction in the form of weak contractions. Although amniotomy and augmentation with oxytocin are frequently used to augment labor, they have not lessened the frequency of CS. The beta-blocker propranolol, given intravenously, reportedly increases uterine activity, and it has safely augmented labor in a small series of primiparous women. The present study evaluated a combination of intravenous propranolol and oxytocin, compared with oxytocin alone, in women arrested in the first stage of labor. The study, a prospective, randomized, double-blind trial undertaken at a large university hospital, enrolled 107 women whose first-stage arrest of labor was ascribed to inadequate uterine contractions. All of them received oxytocin infusion and, in addition, were randomized to received either 2 mg propranolol intravenously or placebo in a 10-minute period. A second dose was given after 60 minutes if the cervix remained unchanged. Specialists lacking knowledge of the assigned treatment monitored the fetus by cardiotocography (CTG). Women given propranolol had no reduction in rates of CS or vacuum extraction. Rates of spontaneous vaginal delivery were 73% and 85%, respectively, in the propranolol and placebo groups, for a relative risk of 0.86 (95% confidence interval, 0.70-1.05). Excluding women having CS, augmented labor constituted 21% of the entire course of labor in the propranolol group and 29% in placebo recipients. The augmented part of labor was 38 minutes shorter in the propranolol group, a difference that was not statistically significant. Before augmentation, the state of the cervix was the same in the 2 groups. Peak oxytocin infusion rates did not differ significantly. Contractions became stronger over time in both groups, but at no time was there a significant group difference. CTG monitoring disclosed 2 cases of transient bradycardia in each group. In addition, 2 infants in the placebo group had decreased variability and 2 others had missing accelerations. There were no significant group differences in heart rate or blood pressure 1 hour after augmentation. Markers of fetal well-being were comparable in the 2 groups. There was no indication of drug accumulation in women given 2 doses of propranolol.