Ld

Labor Induction

search

Labor Induction, Pitocin Induction, Pitocin Augmentation, Labor Augmentation

  • See Also
  • 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. Pitocin 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. Pitocin 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: 1 mIU/minute
  3. Increase: 1 mU/minute every 15-30 minutes
    1. Base Pitocin rate changes on contractions
    2. After 8 mIU/minute
      1. May then increase by 2 mIU/minute
  4. Maximum: 40 mIU/minute
  • Protocol
  • High Dose (nulliparous patients only)
  1. See Monitoring below
  2. Start: 6 mIU/minute
  3. Increase: 1-6 mIU/minute every 20 minutes
  4. Maximum: 40-42 mIU/minute
  • Monitoring
  1. 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
  2. Maternal Vital Signs
  3. Continuous Electronic Fetal Monitoring (CEFM)
  • Alternative methods
  1. Birth pool as effective as Oxytocin augmentation
    1. Less pain and less use of epidural analgesia
    2. Cluett (2004) BMJ 328:314-8 [PubMed]
  • Efficacy
  1. 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. Decrease labor duration by 2 hours without added risk
    2. Merrill (1999) Obstet Gynecol 94:455-63 [PubMed]