Summary This is a short summary on the use of oxytocin for the augmentation of labour.

Precautions

There should be no evidence of cephalopelvic disproportion (CPD)
Abnormal fetal presentation (including breech) should be ruled out.
There should be no evidence of fetal distress.
You should be able to use continuous CTG monitoring.
- Oxytocin infusion should be performed with caution since there is a risk of uterine hyperstimulation, fetal distress, and uterine rupture.
Do not use in patients with a previous c-section and use in caution in patients who are multiparous. These patients will be at risk of uterine rupture.
Should only be performed if the facility has the equipment to manage a potentail complication (failure to achieve vaginal birth, fetal distress)

How to prepare the infusion

Keep this mind: 1 IU/mL = 1000 mIU/mL; 1mIU/mL = 0.001 IU/mL
You can either add 2 IU of Oxytocin in a 200ml of Normal Saline or 10IU into 1000ml of Normal Saline. Hence, each ml has 10mIU of Oxytocin.
Starting Rate: 2mIU/min which is 120mIU/hour (12ml/hour).
- Calculations: We start the oxytocin infusion at 2mIU/min, therefore 2 x 60mins = 120mIU/hour. Now, we known that each ml has 10mIU hence we divided 120 by 10 and get 12ml/hour.
Increment Rate:
- The rate should be increased by 12ml/hour every 30mins until you feel a minimum of 3 strong contractions (>40s) in 10 minutes.
- Most women would develop adequate uterine contractions when reaching 72ml/hour.
- The max rate should be 120 mL/hour (20 mIU/minute).
Maintenance: When adequate contractions are reached, do not increment the rate any further.
Delivery: If the patient’s labour has not progressed adequately within 4 hours while on an oxytocin infusion then you should consider a c-section. This means that the patient would have reached a rate of 108ml/hour (18mIU/minute).

References and Further Reading Link

Published on January 6, 2023

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