From the Guidelines
Oxytocin infusion should be held during labor when there are signs of uterine hyperstimulation, abnormal fetal heart rate patterns, or when the contractions become too frequent or prolonged, as indicated by the most recent and highest quality study 1. When to hold oxytocin infusion during labor is a critical decision that prioritizes maternal and fetal safety. The key indications for holding oxytocin infusion include:
- Uterine hyperstimulation, characterized by contractions that occur more frequently than every 2 minutes, last longer than 90 seconds, or if there are more than 5 contractions in a 10-minute period
- Abnormal fetal heart rate patterns, such as late decelerations, severe variable decelerations, or prolonged bradycardia, as outlined in the NICHD Category II and III FHR tracings 1
- Elevated uterine resting tone (>25 mmHg on intrauterine pressure monitoring)
- Imminent delivery or emergency cesarean delivery
According to the American Family Physician guidelines 1, discontinuing oxytocin infusion is recommended when there are abnormal electronic fetal monitoring findings, such as recurrent, moderate to severe variable decelerations. Additionally, the guidelines suggest that oxytocin should be discontinued if contractions occur more frequently than every 2 minutes, last longer than 90 seconds, or if there are more than 5 contractions in a 10-minute period.
The most recent study 1 highlights the importance of careful monitoring and appropriate cessation of oxytocin infusion to prevent iatrogenic complications, such as uterine rupture, and to ensure a positive birth experience. The study emphasizes that the injudicious use of uterotonics, including oxytocin, can lead to life-threatening complications and long-term consequences for women.
In summary, holding oxytocin infusion during labor is crucial when there are signs of uterine hyperstimulation, abnormal fetal heart rate patterns, or when the contractions become too frequent or prolonged. Discontinuing oxytocin infusion in these situations can help prevent maternal and fetal complications and ensure a safe and positive birth experience 1.
From the FDA Drug Label
If uterine contractions become too powerful, the infusion can be abruptly stopped, and oxytocic stimulation of the uterine musculature will soon wane The oxytocin infusion should be discontinued immediately in the event of uterine hyperactivity or fetal distress
The oxytocin (OT) infusion should be held in the following situations:
- Uterine hyperactivity: if uterine contractions become too powerful
- Fetal distress: if there are signs of fetal distress In these cases, the infusion should be discontinued immediately 2.
From the Research
Holding Oxytocin (OT) Infusion During Labor
- Oxytocin infusion should be held or adjusted in cases of uterine hyperstimulation or abnormal fetal heart rate patterns 3, 4, 5.
- The decision to hold oxytocin infusion may depend on the specific labor management protocol being used, such as low-dose oxytocin infusion or traditional protocols 3, 4.
- Uterine hyperstimulation and fetal distress can be reversed by discontinuing oxytocin infusion or using tocolytic drugs 6.
- Factors that may increase the risk of fetal heart rate anomalies, such as early amniotomy and high doses of oxytocin, should be carefully considered when deciding whether to hold oxytocin infusion 5.
- The use of oxytocin for labor induction should be carefully managed, taking into account the potential risks and benefits, including hyperstimulation, failed induction, and uterine rupture 7.
Specific Scenarios for Holding Oxytocin Infusion
- Uterine hyperstimulation: oxytocin infusion should be held or adjusted to prevent further stimulation 3, 4.
- Abnormal fetal heart rate patterns: oxytocin infusion should be held or adjusted to prevent further fetal distress 3, 4, 5.
- Fetal distress: oxytocin infusion should be held or adjusted, and other interventions such as tocolytic drugs or intrauterine resuscitation techniques may be considered 6, 5.