A conservative oxytocin labor protocol: Is less best?

In a study performed at Duke University Hospital in Durham, North Carolina, a more conservative oxytocin protocol led to lower oxytocin maximal dosing and lower NICU admission rates, but higher rates of postpartum blood loss, wound infection, and cesarean delivery.

The researchers conducted a retrospective cohort study of women receiving oxytocin for labor induction or augmentation before and after implementation of the new protocol. Outcomes were compared for the last 150 women on the old protocol with the first 150 women receiving oxytocin with the new protocol.

There were no differences in age, racial or ethnic makeup, gestational age of delivery, or indication for oxytocin between groups. There was a trend toward more cesarean deliveries (28% compared with 19%, P=.07), greater blood loss among women delivering by cesarean (800 compared with 600 mL, P=.003), and more postcesarean delivery wound complications (23.8% compared with 10.3%, P=.025) among women receiving oxytocin on the new compared with the old protocol. However, there were fewer NICU admissions (11% compared with 20%, P=.038) of neonates from women on the new protocol.

An older study found a reduction in cesarean deliveries

“Dosing of oxytocin and timing of level of increase in dose has been the subject of many scientific publications,” noted study coauthor and Contemporary OB/GYN editorial board member Haywood Brown, MD. “Prior studies have suggested that high-dose protocols are equally or more efficacious than lower-dose protocols for successful vaginal delivery. However, more is not necessarily better. In this study ... there was a lower maximal oxytocin dosing and lower NICU admissions compared to a [more aggressive] protocol.

“Oxytocin is not a benign drug that is heavily used in modern obstetrical practice and less may indeed be best.”

Lewis LS, Pan HY, Heine RP, Brown HL, Brancazio LR, Grotegut CA. Labor and pregnancy outcomes after adoption of a more conservative oxytocin labor protocol. Obstet Gynecol. 2014;123(Suppl 1):66S. doi: 10.1097/01.