Oxytocin

Obtain baseline 30 min FHR tracing prior to initiation

of oxytocin
Continuous monitoring must be maintained when oxytocin used. Patient may have bathroom privileges if
fetal head is well engaged
Uterine activity must be continuously monitored during
oxytocin infusion
Ensure that anesthesia workup has been completed
prior to initiation of oxytocin
Start oxytocin at one of the following protocols, as indicated by patient condition:

Low Dose Protocol

Clinically indiStart Oxytocin infusion at 1-2 millicated in patient
units/minute and increase by 1-2 milliwith a Bishop
units/minute every 30 minutes based
Score of 8,
on fetal response, until uterine contracor with augtions are of moderate quality by
mentation for
palpation or 50-60 mm Hg above basesecondary arline with use of IUPC, or at a rate of 3rest in active
5 contractions in 10 minutes
labor.

Oxytocin
High Dose Protocol
Start Oxytocin infusion at 3-6 milliunits/minute and increase by 3-6
Clinically indimilliunits/minute every 30 minutes
cated in patient
based on fetal response, until
with a Bishop
uterine contractions are of moderScore of < 8, or
ate quality by palpation or 50-60
arrest of dilation in
mm Hg above baseline with use of
1st stage of labor.
IUPC, or at a rate of 3-5
contractions in 10 minutes
Bishop Score
Factor:
Dilation:

1
Closed

2
1-2

Effacement: 0-30% or 40-50% or

3-4
2-3
Station:
Consistency:
Cervical
Position:

3
3-4

>5

60-70% or
1-2

>80% or
<1

-3

-2

-1/0

+1/+2

Firm

Medium

Soft

----

Posterior

MidPosition

Anterior

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Oxytocin

Oxytocin can be increased at a frequency greater

than 30 minutes, but no less than 30 minutes
Alert physician and do not increase oxytocin
dose if, over the last 30 minutes:
FHR does not have moderate variability in at
least 10 minutes
6 or more contractions in 10 min. averaged
over 30 min. window
2 or more contractions are greater than 120 sec.
Uterus does not palpate soft between contractions
IUPC is in place and MVU is calculated at
more than 300 mm Hg
IUPC is in place and uterus resting tone is
greater than 25 mm Hg
Document FHR and uterine activity:
At the start of the oxytocin infusion
15 min. after initiation
At the time of any rate change
15 min. after any rate change
@ least q30min during maintenance in latent
labor; @ least 15 min during maintenance in
active and second stage labor

Oxytocin

Maternal Vital signs

Q30min in latent labor
Q15 in active and second stage labor
Evaluate/document RR q1hr
If the pt has an IUPC placed, evaluate/document
MVUs q1hr during oxytocin infusion between the
rates of 0.5-20 miliunits/min., and q30min if oxytocin is running at a rate of > 20 milliunits/min
Do not go past 20 milliunits/min without a physician order
Adjust oxytocin dose in the presence of tachysystole in the following manner, in sequential order,
per clinical judgment:
Oxytocin-Induced Tachysystole with a
Category I FHR
Maternal repositioning (L or R lateral)
IV fluid bolus of approximately 500 mL
(unless fluid restricted)
After 10 minutes, notify physician if tachysystole (6 contractions in 10 minutes) continues. Consider decreasing oxytocin by at
least half

Oxytocin
Oxytocin-Induced Tachsystole with a
Category I FHR Cont.
If uterine activity has not returned to normal
after 10 minutes, notify physician and consider discontinuing oxytocin
Oxytocin-Induced Tachysystole with a
Category II FHR
Maternal repositioning (L or R lateral)
IV fluid bolus of approximately 500 mL
(unless fluid restricted)
Consider oxygen 10L/min via facemask if
the tracing is suggestive of fetal hypoxia and
the first two interventions do not resolve the
FHR pattern of concern. Discontinue oxygen ASAP
If uterine activity and FHR have not returned to normal (< 6 in 10 minutes) in 10
min, decrease oxytocin by half (notify physician)
If uterine activity and FHR have not returned to normal after 10 min, notifiy physician immediately and discontinue oxytocin
pending new physician order

Oxytocin

Oxytocin-Induced Tachysystole with a

Category III FHR
If not already done, alert physician and
have them evaluate the patient at the bedside
Maternal repositioning (L or R lateral)
IV fluid bolus of approximately 500 mL
(unless fluid restricted)
Discontinue oxytocin (notify physician immediately if not already at the bedside)
Have Terbutaline, 1cc syringe, blunt tip
needle, and subcutaneous needle present at
bedside. If no response in FHR tracing,
consider 0.25 mg Terbutaline subcutaneously. Obtain order prior to administration

Resumption of Oxytocin after Resolution of

Tachysystole

W/in 20 min after discontinuing oxytocin

infusion, the RN and physician will discuss
POC. An order is required to restart pitocin.

Oxytocin

Resumption of Oxytocin after Resolution of

Tachysystole Cont.

If oxytocin has been discontinued for less

than 30 minutes, and contraction frequency,
intensity, and duration are normal, may
resume oxytocin at no more than half the
rate that caused the tachysystole and gradually increase the rate as needed and appropriate based on maternal-fetal status
If oxytocin is discontinued for more than
30 minutes, resume oxytocin at the initial
dose, and increase as needed and as appropriate based on maternal-fetal status.
For FHR Pattern Demonstrating Fetal Bradycardia and/or Recurrent Decelerations:
If not already done, alert physician and have
them evaluate the patient at bedside
Maternal positioning (L or R lateral)
IV fluid bolus of approximately 500 mL
(unless fluid restricted)
Consider oxygen at 10 mL/min via facemask if the first interventions mentioned do
not resolve the Category II or III FHR

Oxytocin

For FHR Pattern Demonstrating Fetal Bradycardia and/or Recurrent Decelerations

Cont:
Discontinue oxytocin (notify physician immediately if not already at the bedside)

Resuming Oxytocin after Discontinued due to

FHR Tracing:

W/in 20 min after discontinuing oxytocin

infusion, the RN and physician will discuss
POC. An order is required to restart pitocin.
If restarting oxytocin w/in 30 min, restart at
half the infusion rate when discontinued
If restarting oxytocin more than 30 minutes
after discontinuation, resume at the original
ordered rate (High or Low Dose Protocol
starting rate)

Oxytocin

Alert physician if patient is on 20 milliunits/min

of oxytocin and signs of water intoxication occur
as an unexpected finding:
Headache, N/V, Mental Confusion, Decrease
Urinary Output (< 15 mL urine per hour), Hypotension, Tachycardia, Cardiac Arrhythmia,
Convulsions
Assess for s/s of impending or actual uterine rupture:
Uterine Tenderness, Suprapubic Pain, Uterine
Tachysytole, Abdominal Rigidity, Vaginal
Bleeding, Indeterminate or Abnormal FHR
Tracing, Loss of Station, Loss of Uterine Pressure, Sudden Cessation of Uterine Contractions, Hypotension, Maternal Tachycardia, Maternal Loss of Consciousness