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Labor Induction

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Labor Induction, Labor Augmentation, Medical Induction of Labor, Oxytocin Induction of Labor, Oxytocin Induction, Pitocin Induction, Oxytocin Augmentation, Pitocin Augmentation

  • Documentation
  1. Indication for Labor Induction
  2. Estimated fetal weight
  3. Fetal Position by Ultrasound
  4. Lung maturity for elective induction before 39 weeks
  5. Normal Fetal Assessment
  • Indications
  1. Labor Augmentation
    1. Failure to Progress (Labor Dystocia)
  2. Labor Induction
    1. Gestation >39 weeks AND Bishop Score >= 5
      1. See Cervical Ripening for Bishop Score <5
    2. Rupture of Membranes
  1. Oxytocin 10 units in 1000 ml Normal Saline
    1. Starting rate of 6-12 ml/hour delivers 1-2 mU/minute
    2. Increasing rate 6 ml/hour delivers another 1 mU/min
  2. Oxytocin 20 units in 1000 ml Normal Saline
    1. Starting rate of 3-6 ml/hour delivers 1-2 mU/minute
    2. Increasing rate 3 ml/hour delivers another 1 mU/min
  • Protocol
  • Low Dose
  1. See Monitoring below
  2. Start: 0.5 to 2 mIU/minute
  3. Increase: 1-2 mU/minute every 15-40 minutes
    1. Base Pitocin rate changes on contractions
    2. After 8 mIU/minute, may then increase by 2 mIU/minute
  4. Maximum: 40 mIU/minute
  • Protocol
  • High Dose
  1. Low dose protocol is preferred in all patients (see efficacy below)
  2. Use only in Nulliparous patients only
  3. See Monitoring below
  4. Start: 6 mIU/minute
  5. Increase: 3-6 mIU/minute every 15-40 minutes
  6. Maximum: 40-42 mIU/minute
  7. As of 2019, evidence is against the use of high dose Oxytocin (See efficacy below)
  • Monitoring
  1. Maternal Vital Signs
  2. Continuous Electronic Fetal Monitoring (CEFM)
  3. Intrauterine pressure catheter
    1. Adequate contraction pattern indicators
      1. Montevideo units >50 mmHg per contraction
      2. Montevideo units 200-300 mmHg per 10 minutes
    2. Observe for signs of hyperstimulation
      1. Fetal Distress
      2. Tetanic contractions
  • Efficacy
  • Labor Augmentation
  1. Oxytocin (Pitocin) is preferred in PROM
    1. Oral Mifepristone less effective, more side effects
    2. Wing (2005) Am J Obstet Gynecol 192:445-51 [PubMed]
  2. High dose Oxytocin Augmentation in Nulliparous women
    1. As of 2019, studies show no benefit in reduced labor time or reduced cesarean rate
      1. Low dose protocol is preferred as just as efficacious as high dose, with less tachysystole
      2. Prichard (2019) J Matern Fetal Neonatal Med 32(3): 362-8 [PubMed]
      3. Budden (2014) Cochrane Database Syst Rev (10): CD009701 [PubMed]
    2. Early studies suggested decreased labor duration by 2 hours without added risk
      1. Merrill (1999) Obstet Gynecol 94:455-63 [PubMed]
  3. Birth pool as effective as Oxytocin Augmentation
    1. Less pain and less use of epidural analgesia
    2. Cluett (2004) BMJ 328:314-8 [PubMed]