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  Chapter 102 Oxytocin - Augmentation and induction of labour infusion regimens 

Disclaimer | Introduction | Oxytocin | Contraindications | Precautions | Induction of labour (IOL) regimen (oxytocin) | Oxytocin induction / augmentation of labour dosage | High concentration / low volume oxytocin IOL dosag | Observations  | References | Last reviewed
 
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Document title:                     Oxytocin: augmentation and induction of labour infusion regimens

First developed:                   29 June 2004

Subsequent updates:          21 April 2009

Last reviewed:                      17 July 2012

ISBN number:                       

Replaces document:            Syntocinon®: augmentation and induction of labour infusion regimens

Author:                                   South Australian Perinatal Practice Guidelines

                                                Workgroup

Audience:                               Medical, midwifery and allied health staff in South Australia public and private maternity services

Endorsed by:                         South Australian Perinatal Practice Guidelines Workgroup

Contact:                                 South Australian Perinatal Practice Guidelines workgroup at: cywhs.perinatalprotocol@health.sa.gov.au

Disclaimer

This guideline provides advice of a general nature.  This statewide guideline has been prepared to promote and facilitate standardisation and consistency of practice, using a multidisciplinary approach.  The guideline is based on a review of published evidence and expert opinion.

Information in this statewide guideline is current at the time of publication.

SA Health does not accept responsibility for the quality or accuracy of material on websites linked from this site and does not sponsor, approve or endorse materials on such links.

Health practitioners in the South Australian public health sector are expected to review specific details of each patient and professionally assess the applicability of the relevant guideline to that clinical situation.

If for good clinical reasons, a decision is made to depart from the guideline, the responsible clinician must document in the patient’s medical record, the decision made, by whom, and detailed reasons for the departure from the guideline.

This statewide guideline does not address all the elements of clinical practice and assumes that the individual clinicians are responsible for:  

>  Discussing care with consumers in an environment that is culturally appropriate and which enables respectful confidential discussion. This includes the use of interpreter services where necessary

>  Advising consumers of their choice and ensuring informed consent is obtained

>  Providing care within scope of practice, meeting all legislative requirements and maintaining standards of professional conduct and,

>  Documenting all care in accordance with mandatory and local requirements


Introduction

>  Oxytocin is a hormone released from the posterior pituitary. As it stimulates rhythmic contractions of uterine smooth muscle, it can be used to induce or augment labour (MIMS Syntocinon® full prescribing information 2009) and to prevent or treat  postpartum haemorrhage 

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Oxytocin

>  Oxytocin (Syntocinon®) is a synthetic nonapeptide identical with oxytocin. 

>  In the doses used it has only a very slight pressor and anti-diuretic activity (MIMS Syntocinon® full prescribing information 2009)

>  Intrapartum oxytocin infusion regimens may be administered in the following:

>  Induction of labour

>  Augmentation of labour

>  There is no hard evidence to recommend a particular dosage of oxytocin for induction or augmentation of labour infusion regimens.  Oxytocin infusion regimens in this guideline are based on medical expert consensus

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Contraindications

>  Hypersensitivity to oxytocin (Syntocinon®)

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Precautions

>  In women who have diabetes mellitus or abnormal glucose tolerance in pregnancy, oxytocin should be administered with 0.9 % sodium chloride to prevent hyponatraemia

>  In women with cardiovascular disorders the infusion volume should be kept low by using a more concentrated oxytocin solution (for more information on prophylaxis management of the third stage of labour in volume critical patients, see Chapter 64 Cardiac disease in pregnancy, Postpartum)

>  Avoid large volumes of oral and IV fluids with oxytocin administration 

 

 

Water intoxication (Hyponatraemia)

>  High doses of oxytocin or prolonged periods of infusion of oxytocin in electrolyte-free fluids may interfere with vasopressin receptors. This can result in water intoxication

 

Symptoms and signs of water intoxication:

>  Headache, nausea, vomiting and abdominal pain, lethargy, drowsiness, unconsciousness, grand mal type seizures , low blood electrolyte concentration

 

Treatment

>  Discontinue oxytocin infusion

>  Restrict fluid intake

>  Promote diuresis

>  Correct electrolyte imbalance

>  Control convulsions

>  If coma is present:  maintain a free airway, and carry out the routine measures for care of an unconscious patient

 

 

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Induction of labour (IOL) regimen (oxytocin)

RCOG (2001) recommends the following oxytocin regimen guidelines:

>  Allow a delay of six hours after administration of the last dose of vaginal prostaglandins before commencing oxytocin 

>  In women with intact membranes, amniotomy should be performed where feasible before starting a oxytocin infusion

>  Use the minimum dose possible and aim for a maximum of 3 – 4 contractions in ten minutes

>  Prescribe and record the dose of oxytocin being delivered (i.e. mU / minute)

>  Continuous CTG whenever oxytocin is used for induction or augmentation

>  Follow link to Induction of labour techniques for further information

>  The oxytocin high dose regimen for IUFD is covered in chapter 102b

 

>  The following regimen is consistent with RCOG and oxytocin (Syntocinon®) product guidelines.  However, individual organisations may differ in their management

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Oxytocin induction / augmentation of labour dosage regimen

Preparation

>  Add 10 IU oxytocin to one litre of Hartmann’s solution or sodium chloride 0.9 %

>  Use an appropriate volumetric infusion pump

>  Infuse as a separate line piggybacked into the mainline

Initial rate:

>  12 mL / hour (2 mU / min)

 

Increments:

>  Increase every 30 minutes by 12 mL / hour (2 mU / min)

Maximum:

>  192 mL / hour (32 mU / min)

 

Prolonged oxytocin  infusion

>  if a second litre of oxytocin infusion is required, consider doubling the dose per litre and running the infusion at half the rate (e.g. increase oxytocin dose to 20 units per litre and infuse dose at half the previous rate)

Maximum oxytocin infusion dosage

>  The summary of product guidelines recommends a maximum dose of IV oxytocin 20 mU / minute

>  In cases where labour progress is unresponsive, RCOG recommends higher doses, which should not exceed 32 mU / minute 

 Last reviewed:  14/01/13                                                                      

                                                                                                    

 

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High concentration / low volume oxytocin IOL dosage regimen

>  This is a modification of the above oxytocin  induction of labour regimen, allowing the same dose of oxytocin to be administered in 1 / 10th the volume of 0.9 % sodium chloride

>   Suitable for women with a cardiovascular disorder, who are sensitive to fluid overload

Preparation

>  Add 10 I.U oxytocin to a 100 mL bag of

0.9 % sodium chloride

>  Use an appropriate syringe pump

>  Infuse as a separate line piggybacked into the mainline at the IV insertion point

Initial rate:

>  Commence oxytocin at 0.6 - 1.2 mL / hour (1-2 mU / min)

Increments

>  Increase every 30 minutes by 1.2 mL / hour (2 mU / min)

Maximum

>  19.2 mL / hour (32 mU / min)

 

Maximum oxytocin infusion dosage

>  The summary of product guidelines recommends a maximum dose of IV oxytocin

20 mU / minute

>  In cases where labour progress is unresponsive, RCOG recommends higher doses, which should not exceed 32 mU / minute 

                                                                                                         

Last reviewed:  14/01/13

 

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Observations 

Induction of labour

>  Routine labour observations (partograph)

Uterine hypercontractility without signs of fetal compromise:

>  Reduce oxytocin infusion rate and seek review

Uterine hypercontractility with associated signs of fetal compromise:

>  Prolonged use of maternal facial oxygen therapy may be harmful to the baby and should be avoided. There is no research evidence evaluating the benefits or risks associated with the short-term use of maternal facial oxygen therapy in cases of suspected fetal compromise (NICE 2007)

>  Decrease or discontinue oxytocin

>  Position woman on her left side

>  Increase intravenous fluids

>  Review by medical officer 

>  Oxygen at 8 litres for duration of fetal compromise

>  Palpate the uterus to determine uterine response to management

>  Consider need for uterine tocolytic e.g. salbutamol (link to tocolysis for uterine hypercontractility)

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References

  1. MIMS Syntocinon®.  Full prescribing information. July 2009. 
  2. Grotegut CA, Paglia MJ, Johnson LNC, Thames B, James AH.  Oxytocin exposure during labor among women with postpartum hemorrhage secondary to uterine atony.  Am J Obstet Gynecol 2011; 204: 56. e1-6.
  3. Novartis Pharmaceuticals Australia.  Syntocinon® (synthetic oxytocin).  Product information Australia 1994.
  4. Royal College of Obstetricians and Gynaecologists (RCOG).  Induction of labour, Evidence-based Clinical Guideline Number 9.  RCOG Clinical Effectiveness Support Unit, London: RCOG Press; 2001.
  5. National Institute of Clinical Excellence (NICE).  Intrapartum care: care of healthy women and their babies during childbirth.  NICE Clinical guideline 55, London: RCOG Press; 2007.  Available from URL: http://www.nice.org.uk/nicemedia/live/11837/36280/36280.pdf
  6. Fawole B, Hofmeyr GJ. Maternal oxygen administration for fetal distress. Cochrane Database of Systematic Reviews 2003, Issue 4. Art. No.: CD000136. DOI: 10.1002/14651858.CD000136.  Available from URL:  http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000136/pdf/standard
  7. MIMS Duratocin®.  Full prescribing information.  March 2008.

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First developed: 29 June 2004    Subsequent updates:  21 April 2009; 17 July 2012

Last reviewed: 14 January 2013

South Australian Perinatal Practice Guidelines. Please read our disclaimer.

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