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Poster Session 4

Category: Labor

Poster Session 4

(1213) Oxytocin Dosing During TOLAC to Minimize the Uterine Rupture Risk: A Systematic Review and Meta-Analysis

Thursday, February 12, 2026

3:30 PM - 5:00 PM

Submitting Author and Presenting Author(s)

PN

Pierpaolo Nicolì, MD

Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (DIM), University of Bari “Aldo Moro”, Policlinico of Bari, Piazza Giulio Cesare 11, 70124, Bari, BA, Italy
Bari, Puglia, Italy

Coauthor(s)

Moti Gulersen, MD, MSc

Assistant Professor
Thomas Jefferson University
PHILADELPHIA, Pennsylvania, United States
Jordan Beacham, BA

Medical Student
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
Philadelphia, Pennsylvania, United States
Hila Hochler, MD

Department of obstetrics and gynecology, Hadassah Mount-scopus, Jerusalem
Laniado Medical Center, Netanya, Israel
Natanya, HaMerkaz, Israel
Alessandra Familiari, MD (she/her/hers)

Researcher
Department of Women and Child Health, Women Health Area, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Università Cattolica del S. Cuore, Rome, Italy
Rome, Lazio, Italy
Anna Locatelli, MD (she/her/hers)

School of Medicine and Surgery, University of Milano-Bicocca
Milan, Lombardia, Italy
CA

Cynthia Abraham

Hofstra University - Northwell Health System, Staten Island University Hospital, Staten Island, NY
New York City, New York, United States
EC

Ettore Cicinelli

Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (DIM), University of Bari “Aldo Moro”, Policlinico of Bari, Piazza Giulio Cesare 11, 70124, Bari, BA, Italy
Bari, Puglia, Italy
AV

Amerigo Vitagliano

Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (DIM), University of Bari “Aldo Moro”, Policlinico of Bari, Piazza Giulio Cesare 11, 70124, Bari, BA, Italy
Bari, Puglia, Italy
Vincenzo Berghella, MD (he/him/his)

Professor, Director
Thomas Jefferson University
Philadelphia, Pennsylvania, United States

Objective:
To assess which oxytocin protocol, in terms of initial dose, increase amount, timing to next increase, and max dose, may minimize the uterine rupture (UR) risk during trial of labor after cesarean (TOLAC).

Study Design:
PubMed, Embase, and Clinicaltrials.gov were searched up to September 21, 2024. RCTs and nonrandomized studies evaluating the association between oxytocin for induction and/or augmentation and UR in TOLAC vs. spontaneous TOLAC were eligible. Eligible studies had to report at least one oxytocin protocol component (initial dose, increase amount, timing to next increase, or max dose). The primary outcome was UR. Effect measures (odds ratios [ORs] with 95% confidence intervals [95%CI]) were calculated using a random-effects model and pooled via meta-analyses. Oxytocin exposure was categorized into three analyses: any use (induction and/or augmentation), induction only, and augmentation only. Subgroup analyses assessed differences based on initial dose (≤ 2 vs > 2 mU/min), increase amount (≤ 2 vs > 2 mU/min), timing to next increase (< 30 vs ≥ 30 min), and max dose (≤ 20 vs > 20 mU/min). Sensitivity analyses were performed by excluding studies with < 1,000 patients.

Results:
Twenty-one observational studies including 51,025 TOLAC patients were analyzed. Oxytocin was associated with increased UR risk in any use (OR, 1.80 (95%CI, 1.23-2.63), p=0.003, I²=0%) and augmentation only (OR, 1.87 (95%CI, 1.05-3.33), p=0.03, I²=0%). While initial dose and increase amount were not associated with UR, oxytocin administered at intervals < 30 min (any use [sensitivity analysis] OR, 1.88 [95%CI, 1.01-3.51], p=0.047, I²=0%) and at a max dose > 20 mU/min (any use OR, 2.17 [95%CI, 1.28-3.70], p=0.004, I²=0%; augmentation only OR, 2.79 [95%CI, 1.03-7.54], p=0.04, I²=0%) was associated with increased UR risk (Table).

Conclusion:
Oxytocin dosing during TOLAC was associated with increased UR risk. Specifically, the risk was raised with dose escalation intervals < 30 min and max doses > 20 mU/min, while no clear relationship emerged for initial dose or increase amount. RCTs are needed to confirm the safest regimen.