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Labor and Pregnancy Outcomes After Adoption of a More Conservative Oxytocin Labor Protocol

Lewis, Lauren S. MD; Pan, Ho-Yu RN; Heine, R. Phillip MD; Brown, Haywood L. MD; Brancazio, Leo R. MD; Grotegut, Chad A. MD
Obstetrics & Gynecology: May 2014
doi: 10.1097/01.AOG.0000447374.37308.4c
Monday, April 28, 2014: PDF Only

INTRODUCTION: Recently, oxytocin has been classified as a high-alert medication. Opinion statements have recommended more conservative oxytocin protocols and our labor and delivery unit changed its protocol by decreasing maximal infusion rates, lengthening time between dose changes, and adjusting infusion rates to uterine response. Our objective was to determine if implementation of this oxytocin labor protocol affected cesarean delivery rates and maternal and neonatal outcomes.

METHODS: We conducted a retrospective cohort study of women receiving oxytocin for labor induction or augmentation at Duke University Hospital before and after implementation of the new protocol. Outcomes were compared for the last 150 women on the old protocol with the first 150 women receiving oxytocin with the new protocol.

RESULTS: There were no differences in age, racial or ethnic makeup, gestational age of delivery, or indication for oxytocin between groups. There was a trend toward more cesarean deliveries (28% compared with 19%, P=.07), greater blood loss among women delivering by cesarean (800 compared with 600 mL, P=.003), and more postcesarean delivery wound complications (23.8% compared with 10.3%, P=.025) among women receiving oxytocin on the new compared with the old protocol. However, there were fewer intensive care nursery admissions (11% compared with 20%, P=.038) of neonates from women on the new protocol.

CONCLUSION: A more conservative oxytocin protocol led to lower oxytocin maximal dosing and lower intensive care nursery admission rates but greater postpartum blood loss, wound infection, and a trend toward higher cesarean delivery rates. Oxytocin protocols must balance maternal and neonatal morbidity associated with exposure to this high-risk medication.

Financial Disclosure: Lauren S. Lewis, MD, Ho-Yu Pan, RN, R. Phillip Heine, MD, Haywood L. Brown, MD, Leo R. Brancazio, MD, and Chad A. Grotegut, MD—These authors have no conflicts of interest to disclose relative to the contents of this presentation.

© 2014 by The American College of Obstetricians and Gynecologists.