Place label here pitocin (oxytocin) Induction / Augmentation

INDICATION FOR INDUCTION:  N/A - augmentation

1. Follow Labor Admission Orders (seq # 9044) and Normal Vaginal Delivery Clinical Pathway

2. 
   External fetal monitoring for 20 min prior to starting Pitocin (oxytocin). For Category II or III FHR patterns, hold Pitocin (oxytocin) and notify physician/CNM
   
3. 
   Maternal VS, FHR, and uterine activity per policy # 7007-08
   

4. 
   Pitocin (oxytocin)15 units in NS 250 ml, piggyback through an infusion pump to the mainline IV
   

Increase by 2 milliunits/min q 30 min until 2-5 regular uterine contractions q 10 min.

If 20 milliunits/min is reached, perform SVE and notify physician/CNM

OR

 Start Pitocin (oxytocin) infusion at  1 milliunit/min OR  2 milliunits/min

Increase by  1 OR  2 milliunits/min q 30 min until 2-5 regular uterine contractions q 10 mins.

If 20 milliunits/min is reached, perform SVE and notify physician/CNM

5. 
   If uterine tachysystole, implement Pitocin (oxytocin) Induced Tachysystole protocol (see reverse)
   

______________ _____________ _________________________________ ___________

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  Maternal repositioning (left or right lateral position)
  
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  IV fluid bolus of at least 500 mL lactated Ringer’s solution
  
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  If uterine activity has not returned to normal after 10-15 minutes
  
  • 
    Reduce oxytocin rate by at least half
    
  • 
    If uterine activity has not returned to normal after 10-15 additional minutes
    
    • 
      Discontinue oxytocin until uterine activity is no more than five contractions in 10 minutes
      
  • 
    If patient is in the latent phase of labor (less than 4 cm dilated) and having mild (to palpation) high-frequency, low-amplitude contractions, contact physician/CNM to determine plan of care. In this clinical scenario, it may be acceptable to continue titration of Pitocin (oxytocin).
    
  • 
    If patient has an IUPC in place, and documented Montevideo units are less than 250 MVUs, contact physician/CNM to determine plan of care. In this clinical scenario, it may be acceptable to continue titration of Pitocin (oxytocin).
    

• 
  Discontinue Pitocin (oxytocin)
  
• 
  Maternal repositioning (left or right lateral position)
  
• 
  IV fluid bolus of at least 500 mL lactated Ringer’s solution
  
• 
  Oxygen at 10 L/min via nonrebreather facemask (discontinue as soon as possible based on fetal response)
  
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  Give terbutaline 0.25 mg SQ if:
  
  • 
    Prolonged deceleration
    
  • 
    No response after 10-15 minutes
    

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  If Pitocin (oxytocin) has been discontinued for less than 30 minutes, there is a Category I tracing, and contractions are no more than five in 10 minutes
  
  • 
    Resume Pitocin (oxytocin) at no more than half the rate that was being given at the time of tachysystole
    
  • 
    Resume titration as ordered
    
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  If Pitocin (oxytocin)has been discontinued for at least 30 minutes, there is a Category I tracing, and contractions are no more than five in 10 minutes
  
  • 
    Resume Pitocin (oxytocin) at initial dose ordered
    
  • 
    Resume titration as ordered