Table 3.
Clinical Guidance for Use of Exogenous Oxytocin (Pitocin)
| Organizational Dosing Recommendations | Adverse Side Effects | Tips for Optimal Use from State of the Science Review of Literature | |||
|---|---|---|---|---|---|
| AWHONN 71 |
ACOG
2
Low-dose regimen |
SOGC Low-dose regimen 74 | Uterine tachysystole, Fetal heart rate changes, Meconium staining of amniotic fluid, Placental abruption, Amniotic fluid embolism, and Water intoxication75 |
For cervical ripening: Initiate with Bishop score <4 only if contraindications to prostaglandins.34 | |
| Starting dose | 1 mU/min | 0.5–2 mU/min | 1–2 mU/min | ||
| Increment dose | 1–2 mU/min | 1–2 mU/min | 1–2 mU/min |
For latent phase of induction of labor: Latent labor occurs over a longer duration than spontaneous labor (hours to move from 3–6cm dilation: nulliparous 19.2h IOL vs. 7h SOL; multiparous 22.3h IOL vs 5.9h SOL).62 |
|
| Frequency of dose increase | Every 30–60 minutes | Every 15–40 minutes | Every 30 minutes |
For active phase of induction of labor: Consider reducing the infusion rate or discontinuing oxytocin infusion.63 |
|
| Maximum dose | 20 mU/min | None | 30 mU/min (Denotes “usual dose” for labor 8–12 mU/min) | An infusion rate of 11–13 mU/min has been identified as the rate where most women should experience adequate contractions and cervical change.68 | |
Abbreviations: ACOG, American College of Obstetricians and Gynecologists; AWHONN, Association of Women’s Health, Obstetric and Neonatal Nurses; SOGC, The Society of Obstetricians and Gynaecologists of Canada; IOL, induction of labor; SOL, spontaneous onset of labor; mU, milliunits; min, minutes.