Continuous cardiotocographic monitoring of foetal wellbeing is essential during induced or augmented labour.
Administration of Syntocinon (oxytocin) is by slow infusion, preferably using a pump with a drop counter.
NICE has stated that (1):
- oxytocin should not be started for 6 hours following administration of vaginal prostaglandins
- in women with intact membranes amniotomy should be performed where feasible prior to commencement of an infusion of oxytocin
- when induction of labour is undertaken with oxytocin the recommended regimen is:
- a starting dose of 1-2 milliunits per minute
- increased at intervals of 30 minutes or more
- the minimum dose possible of oxytocin should be used and this should be titrated against uterine contractions aiming for a maximum of 3-4 contractions every 10 minutes
- adequate contractions may be established at 12 milliunits per minute
- in the summary of product characteristics (SPC) the licensed maximum dose is 20 milliunits per minute
- if higher doses are used the maximum dose used should not exceed 32 milliunits per minute
- local protocols for delivery of oxytocin for induction of labour should:
- specify and use the dose of oxytocin being delivered (milliunits per minute or mU/min) in preference to the volume of fluid being infused (millilitres per minute or ml/min). be delivered through a syringe driver or via an infusion pump with a non-return valve
- to reduce error, a standard dilution should always be used
- suggested standardised dilutions and dose regimens include:
- 30IU Oxytocin in 500mls of normal saline, hence 1ml/hr = 1 milliunit Oxytocin per minute
- 10IU Oxytocin in 500mls of normal saline, hence 3mls/hr = 1 milliunit Oxytocin per minute
If there are any signs of foetal distress or hypertonic uterine activity then the infusion is stopped immediately. Otherwise the infusion should be continued until the third stage of labour is completed.
The summary of product characteristics, as well as reference to local and national guidelines, must be consulted before administration of a syntocinon (oxytocinon) infusion.
Reference:
- NICE (June 2001). Induction of Labour