Improving Neonatal and Maternal Outcome by Inducing Mild Labor before Elective Cesarean Section: The Lacarus Randomized Controlled Trial

<b><i>Background:</i></b> Newborns delivered by elective cesarean section (CS) are at higher respiratory risk than those vaginally or CS proceeded labor (secondary CS). The oxytocin challenge test (OCT) induces uterine contractions that trigger the release of fetal hormones regulating lung fluid clearance during transition from to an air-breathing environment. <b><i>Objectives:</i></b> aim is summarize current evidence and outline Lacarus trial protocol. <b><i>Methods:</i></b> Literature review informed design a randomized placebo-controlled multicenter OCT preceding in 1,450 women with singleton pregnancy due for >35 weeks gestation, without contractions, rupture membranes, antenatal steroids. comprises infusion 5 IU/500 mL Ringer lactate rate 12 mL/h, doubling every 10 min until inducing per 15-min interval. primary endpoint occurrence neonatal morbidity within 24 h after birth. Secondary endpoints include biochemical physiological parameters maternal well-being, such as breastfeeding plasma copeptin concentrations. <b><i>Conclusion:</i></b> This first hypothesis oxytocin-induced before promising application physiologic principles gleaned natural birth improve outcomes.