4Research implications

Publication Details

The Guideline Development Group (GDG) identified important gaps in existing knowledge that need to be addressed through primary research. It was observed that despite the increasing practice of augmentation of labour worldwide, the paucity of strong evidence was striking. The quality of evidence was rated as low or very low for most of the recommendations. From the GRADE methodology standpoint, evidence rated as low or very low quality implies that further research is likely to have an impact on the corresponding recommendations. Conversely, further research is not a priority for those recommendations based on evidence of moderate or high quality. The knowledge gaps identified based on this concept were prioritized by considering whether such research would be original, innovative, feasible, and likely to promote equity and to contribute to improvement in intrapartum care.

The GDG acknowledged that in spite of the lack of clear benefits for certain interventions that are deeply embedded in clinical practice (e.g. oxytocin alone for augmentation), initiation of rigorous primary studies is likely to face significant ethical and recruitment challenges.

4.1. Key research priorities

  • What are the comparative effects of oxytocin alone, amniotomy alone and concurrent oxytocin and amniotomy in women with confirmed delay in the first stage of labour?
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    How does the sequence of oxytocin and amniotomy as concurrent interventions affect outcomes when used for labour augmentation?

  • What are the effects of antispasmodic agents when used as treatment for confirmed delay in the first stage of labour?

4.2. Other research questions

The following research questions are listed in no particular order of priority:

  • What are the effects of labour augmentation when used for the treatment of delayed labour in women with scarred uterus (i.e. due to previous caesarean section or previous myomectomy)?
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    What are the effects of amniotomy alone when used for the treatment of delayed labour in women with scarred uterus?

  • What are the effects of herbal medications when used for prevention or treatment of delay in labour?
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    What are the effects of interventions to reduce the use of herbal medications in labour?

  • What is the safest maximum dose of oxytocin for labour augmentation?
  • What are the effects of the various methods of labour augmentation when used for the treatment of delayed labour in multiparous compared to the nulliparous women?
  • What is the safest and most effective incremental rate of oxytocin infusion for labour augmentation?