Oxytocin Management Protocol for Labor Induction and Augmentation
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. 1, 2, 3
Preparation and Administration
- Preparation: Combine 10 units (1 mL) of oxytocin with 1,000 mL of physiologic electrolyte solution to create a 10 mU/mL concentration 3
- Administration method: ONLY via intravenous infusion using an infusion pump for accurate control 3
- Setting: Must be administered under adequate medical supervision in a hospital 3
Dosing Protocol
Initial Dosing
- Start with 1-2 mU/min 3
- Increase gradually in increments of 1-2 mU/min 3
- Allow 20-30 minutes between dose increases (based on oxytocin half-life of 8-10 minutes) 4
Dose Adjustment
- Titrate to establish contractions similar to normal labor 3
- Low-dose regimens (with 60-minute intervals between increases) are safer than and equally effective as more aggressive protocols with 20-minute intervals 5
- Most women can be successfully induced with physiological doses of 2-6 mU/min 4
Monitoring Requirements
- Continuous monitoring of:
- Fetal heart rate
- Resting uterine tone
- Frequency, duration, and force of contractions 3
Safety Considerations
When to Discontinue
- Immediately discontinue oxytocin infusion if:
- Uterine hyperactivity occurs
- Fetal distress is detected 3
- Administer oxygen to the mother if complications arise 3
Special Populations
- Previous cesarean delivery: Use with caution as risk of uterine rupture is approximately 1.1% 2
- Respiratory disease: Oxytocin has not been associated with worsening lung function or asthma exacerbation 1
Postpartum Hemorrhage Management
- For control of postpartum bleeding: 10-40 units of oxytocin may be added to 1,000 mL of non-hydrating diluent and run at a rate necessary to control uterine atony 3
- Alternatively, 10 units can be administered intramuscularly after delivery of the placenta 3
- WHO strongly recommends tranexamic acid (within 3 hours of birth) in addition to standard care for clinically diagnosed postpartum hemorrhage 1
Common Pitfalls to Avoid
- Excessive dosing: Using higher doses than necessary increases risk of complications including uterine hyperstimulation 6
- Too-rapid dose escalation: Increasing doses at intervals shorter than 20 minutes can lead to uterine hypercontractility 5
- Inadequate monitoring: Failure to continuously monitor maternal and fetal parameters during oxytocin administration 3
- Water intoxication: High doses of oxytocin have antidiuretic effects; use lowest effective dose 7
Oxytocin is a highly effective agent for labor induction and augmentation when used properly, but requires careful administration and monitoring to avoid complications such as uterine hypercontractility, fetal distress, uterine rupture, and water intoxication 7, 8.