Oxytocin Administration in Labor Induction and Augmentation
Introduction to Oxytocin Administration
- Women requiring labor induction or augmentation should be managed with either low-dose or high-dose oxytocin regimens administered via intravenous infusion with continuous monitoring of fetal heart rate and uterine activity, as recommended by the American College of Family Physicians and the American College of Obstetricians and Gynecologists (ACOG) 1
Patient Selection and Preparation
- Oxytocin should be administered under adequate medical supervision in a hospital setting, as recommended by the American College of Family Physicians 1
- Patients with respiratory disease can be administered oxytocin as it has not been associated with worsening lung function or asthma exacerbation, according to the European Respiratory Society 2
Administration and Monitoring
- Oxytocin should be titrated to establish contractions similar to normal labor, with low-dose regimens (with 60-minute intervals between increases) being safer than and equally effective as more aggressive protocols with 20-minute intervals 1
- Continuous monitoring of fetal heart rate, resting uterine tone, frequency, duration, and force of contractions is necessary during oxytocin administration 1
- The World Health Organization strongly recommends the use of tranexamic acid (within 3 hours of birth) in addition to standard care for clinically diagnosed postpartum hemorrhage 3
Special Considerations
- In patients with a previous cesarean delivery, oxytocin should be used with caution as the risk of uterine rupture is approximately 1.1% (95% CI, 0.9% to 1.5%) and the likelihood of successful vaginal birth after cesarean (VBAC) decreases when labor is induced using oxytocin, as recommended by the American College of Family Physicians 1, 4