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Administration of oxytocin to induce labour

Local policies and protocols should be followed for the administration of oxytocin. Variations occur in the initial dose and the rate of
incrementation of oxytocin used for induction of labour .oxytocin is used intravenously, diluted in an isotonic solution such as normal
saline. Dextrose solutions used over long periods, in conjunction with oxytocin, can alter the electrolyte balance because of the mild
antiduretic effect of the hormone. The infusion should be controlled through a pump to enable accurate assessment of volume and
rate. Dosages should be recorded in minutes per minute. The rate of infusion must be titrated against the assessment of strength
and frequency of uterine contraction. The nurse should aim to administer the lowest dose required to maintain effective, well-spaced
uterine contractions, typically occurring ever 3 minute, lasting 45-50 seconds
PERINATAL PATIENT SAFETY: Management of Oxytocin for Labor Induction
and Augmentation
Kathleen Rice Simpson PhD, RN, MCN, The American Journal of
Maternal/Child Nursing
March/April 2004
Volume 29 Number 2
Pages 136 - 136

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Practices To Promote Patient Safety and Decrease Liability Exposure When

Using Oxytocin

Do you know the leading cause of obstetrical liability claims and payout?
The answer is oxytocin administration leading to hyperstimulation with
subsequent fetal injury (hypoxia/acidosis/asphyxia). This problem is also
completely preventable.

How can you assure better patient safety when using oxytocin? The best
way is to implement one unit policy or protocol that everyone is expected
to follow, one that outlines (in detail) the initial dosage, intervals, dosage
for increases in rate, and interventions for excessive uterine activity
(hyperstimulation) with or without a nonreassuring fetal heart rate (FHR)
pattern. This process should be fairly straightforward, but as every labor
nurse knows, it's not always so. While physicians and nurses all agree on
our mutual goals of having a vaginal birth of a well-oxygenated baby in a
timely manner with an optimal outcome for the mother, there is not
always agreement on the process. Clinical disagreements with physician
colleagues about the management of oxytocin have become an ongoing
issue for many labor nurses.
There is a cumulative body of evidence to suggest that using oxytocin at
high rates, increasing the dosage at intervals inconsistent with basic
pharmacology (less than every 30 to 40 minutes), and causing uterine
hyperstimulation will not result in a clinically significant decrease in the
length of labor ( Crane & Young, 1998 ). Multiple clinical studies and
current data based on physiologic and pharmacologic principles have
shown that 90% of pregnant women at term will have labor successfully
induced with 6mU/min or less of oxytocin ( Simpson, 2002 ). A metaanalysis of low-dose versus high-dose oxytocin for labor induction ( Crane
& Young, 1998 ) found low-dose protocols resulted in fewer episodes of
excessive uterine activity, ...

1. Journal of Perinatal and Neonatal Nursing
June 2002
Volume 16 Number 1
2. PERINATAL PATIENT SAFETY: Management of Oxytocin for Labor
Induction and Augmentation
Kathleen Rice Simpson PhD, RN, FAAN
MCN, The American Journal of Maternal/Child Nursing
March/April 2004
Volume 29 Number 2