Oxytocin Titration Research Articles

A qualitative exploration of the challenges providers experience during peripartum management of patients with a body mass index ≥ 50 kg/m2 and recommendations for improvement.

The objective of this research was to conduct a qualitative study among a diverse group of providers to identify their clinical needs, barriers, and adverse safety events in the peripartum care of people with a body mass index (BMI) ≥ 50 kg/m2. Obstetricians, anesthesiologists, certified nurse midwives, nurse practitioners, and nurses were invited to participate in focus group discussions if they were employed at the hospital for >6 months. Key concepts in the focus group guide included: (1) Discussion of challenging situations, (2) Current peripartum management approaches, (3) Patient and family knowledge and counseling, (4) Design and implementation of a guideline (e.g., checklist or toolkit) for peripartum care. The audiotaped focus groups were transcribed verbatim, uploaded to a qualitative analysis software program, and analyzed using inductive and constant comparative approaches. Emerging themes were summarized along with representative quotes. Five focus groups of 27 providers were completed in 2023. The themes included staffing (level of experience, nursing-patient ratios, safety concerns), equipment (limitations of transfer mats, need for larger sizes, location for blood pressure cuff, patient embarrassment), titrating oxytocin (lack of guidelines, range of uses), monitoring fetal heart rate and contractions, patient positioning, and communication (lack of patient feedback, need for bias training, need for interdisciplinary relationships). Providers gave examples of items to include in a "BMI cart" and suggestions for a guideline including designated rooms for patients with a BMI ≥ 50 kg/m2, defining nursing ratios and oxytocin titration plans, postpartum incentive spirometer, and touch points with providers (nursing, physicians) at every shift change. Providers discussed a range of challenges and described how current approaches to care may negatively affect the peripartum experience and pose threats to safety for patients with a BMI ≥ 50 kg/m2 and their providers. We gathered information on improving equipment and communication among providers.

The Evaluation of Obstetric Outcome of Postdated Pregnancy

Background: Postdated pregnancy is one of the commonest obstetric conditions. Pregnancy is called term when it lies between 37 weeks to 40 weeks from the last menstrual period. If the pregnancy exceeds 40 weeks it is called as postdated pregnancy.
 Methods: From January to June 2022, researchers from the Research institute Dhaka Medical College and Hospital, carried out this prospective observational study. We surveyed 100 participants for this research. After carefully evaluating the woman and the fetus, induction of labor was conducted after the due date had passed. Intact membrane, cephalic presentation, singleton pregnancies, and a low Bishop score in post-dated pregnancies were also requirements for participation. Women with absolute contraindications to induction of labor, such as a contracted pelvis, placenta previa, unexplained vaginal hemorrhage, breech presentation, or a history of caesarean section, were not included in the analysis.
 Results: During the study Sixty percent of the population is comprised of young adults ages 21 to 30. There were 42% in the oxytocin group, 38% in the ARM + oxytocin group, and 14% in the misoprostol group. There were 30% unsuccessful deliveries with oxytocin drip, 25% with ARM + Oxytocin drip, and 14% with misoprostol. The vast majority of births occurred naturally via the cervix, whereas around 33% required a caesarean section and 10% required the use of forceps. The fetal distress rate was 13%, while the cervix conditions were poor in 5%. 75% of the newborns were very fine.
 Conclusion: Timely labor is closely connected with positive birth outcomes. It is critical to make a correct diagnosis of postdatism. With the right advice and constant monitoring from medical professionals, postpartum depression in mothers may be alleviated. Many hospitals around the country resort to caesarean sections to end post-dated pregnancies because of technological limitations in foetal monitoring and oxytocin titration. Inducing labor seems to be safe for both mother and child when a full-term cervix and favorable fetal presentation are present.

Outcome of Medical Induction of Labour in Postdated Pregnancy

Background: WHO and the International Federation of Gynecology and Obstetrics recognise the words "post maturity," "post term," "postdate," and "prolongedpregnancy" to describe pregnancies that continue beyond their intended end points (expected date of delivery). As much as 10% of pregnancies become more complicated due to a pregnancy that lasts longer than expected, and this poses risks to both the mother and the unborn child. Objective: To study of medical induction of labour in post-dated pregnancy. Methods: This prospective observational study was conducted in the Department of Obstetrics and Gynecology, Abdul Malek Ukil Medical College, Noakhali, Bangladesh from January to June 2022. 100 patients included in our study. Labour induction in post-dated pregnancy was performed only after appropriate assessment of the mother and foetus. The inclusion criteria were intact membrane, cephalic presentation, singleton pregnancies, low Bishop score in post-dated pregnancies. Absolute contraindications to induction of labour include contracted pelvis, placenta previa, unexplained vaginal bleeding, presentation other than head and previous caesarean section were excluded from the study. This study shows that the main method was oxytocin drip and second method was ARM+oxytocin in drip, some cases induced by using oral prostaglandin and very few cases induced by intra cervical prostaglandin. Results: During the study 21-31 years age group, 60%. 42% were in oxytocin drip followed by 38% were in ARM + Oxytocin drip, 14% were in misoprostol in oxytocin drip 30% were failed cases followed by in ARM + Oxytocin drip it was 25%, in misoprostol it was 14%. Majority had Spontaneous vaginal delivery followed by 15% had Delivery by Caesarean section and 10% had Delivery with the aid of Forceps. 13% had foetal distress and 5% had unfavorable cervix. 75% were healthy baby and 20% were distress baby. Conclusion: Successful birth outcomes are strongly correlated with labor starting at the optimal time. An accurate diagnosis of postdatism is crucial. Mothers' worries and issues related to postdatism may be reduced with the help of sound guidance and close observation from healthcare providers. Due to technical constraints in foetal monitoring and oxytocin titration, caesarean section is often used to terminate most post-dated pregnancies in various hospitals throughout the nation. When a mature cervix and optimal fetal presentation are present, inducing labor seems to be safe for both the woman and the baby.

An Unexpected Cause of Recurrent Fetal Decelerations

An Unexpected Cause of Recurrent Fetal Decelerations

Implementation of Badge Buddy to Improve Obstetric Nurse Confidence in Oxytocin Titration

Implementation of Badge Buddy to Improve Obstetric Nurse Confidence in Oxytocin Titration

Accelerated Titration of Oxytocin in Nulliparous Women with Labour Dystocia: Results of the ACTION Pilot Randomized Controlled Trial.

The primary objective was to determine the feasibility of a large RCT assessing the effectiveness of an accelerated oxytocin titration (AOT) protocol compared with a standard gradual oxytocin titration (GOT) in reducing the risk of CS in nulliparous women diagnosed with dystocia in the first stage of labour. The secondary objective was to obtain preliminary data on the safety and efficacy of the foregoing AOT protocol. This was a multicentre, double-masked, parallel-group pilot RCT. This study was conducted in three Canadian birthing centres. A total of 79 term nulliparous women carrying a singleton pregnancy in spontaneous labour, with a diagnosis of labour dystocia, were randomized to receive either GOT (initial dose 2 mU/min with increments of 2 mU/min) or AOT (initial dose 4 mU/min with increments of 4 mU/min), in a 1:1 ratio. An intention-to-treat analysis was applied. A total of 252 women were screened and approached, 137 (54.4%) consented, and 79 (31.3%) were randomized. Overall protocol adherence was 76 of 79 (96.2%). Of the women randomized, 10 (25.6%) allocated to GOT had a CS compared with six (15.0%) allocated to AOT (Fisher exact test P = 0.27). This pilot study demonstrated that a large, multicentre RCT is not only feasible, but also necessary to assess the effectiveness and safety of an AOT protocol for labour augmentation with regard to CS rate and indicators of maternal and perinatal morbidities.

Titration of Intravenous Oxytocin Infusion for Postdates Induction of Labor Across Body Mass Index Groups

ObjectiveTo evaluate whether oxytocin titration for postdates labor induction differs among women who are normal weight, overweight, and obese and whether length of labor and birth method differ by oxytocin titration and body mass index (BMI). DesignRetrospective cohort study. SettingU.S. university-affiliated hospital. ParticipantsOf 280 eligible women, 21 were normal weight, 134 were overweight, and 125 were obese at labor admission. MethodsData on women who received oxytocin for postdates induction between January 1, 2013 and June 30, 2013 were extracted from medical records. Oxytocin administration and labor outcomes were compared across BMI groups, controlling for potential confounders. Data were analyzed using χ2, analysis of variance, analysis of covariance, and multiple linear and logistic regression models. ResultsWomen who were obese received more oxytocin than women who were overweight in the unadjusted analysis of variance (7.50 units compared with 5.92 units, p = .031). Women who were overweight had more minutes between rate changes from initiation to maximum than women who were obese (98.19 minutes compared with 83.39 minutes, p = .038). Length of labor increased with BMI (p = .018), with a mean length of labor for the normal weight group of 13.96 hours (standard deviation = 8.10); for the overweight group, 16.00 hours (standard deviation = 7.54); and for the obese group, 18.30 hours (standard deviation = 8.65). Cesarean rate increased with BMI (p = .001), with 4.8% of normal weight, 33.6% of overweight, and 42.4% of obese women having cesarean births. ConclusionWomen who were obese and experienced postdates labor induction received more oxytocin than women who were non-obese and had longer length of labor and greater cesarean rates.

Pre-Induction and Intrapartum Correlates of Successful Induction Of Labour Using Oxytocin and Misoprostol in Abakaliki, Nigeria

Context: Induction of labour (IOL) is a therapeutic challenge and an alternative to Caesarean section. Objectives: To evaluate the success rate of IOL and its determinants at the Ebonyi State University Teaching Hospital (EBSUTH), Abakaliki. Methods: A retrospective study involving 251 parturients who had induction of labour over a five-year period. Results: IOL accounted for 2.9% of the 8,676 deliveries during the study period. The overall success rate for labour induction in EBSUTH was 83.1%. Multiparous women achieved a success rate of 91.4%, grandmultipara 95.7%, and primigravida 58.2%. IOL using Misoprostol had a success rate of 83.1% and Oxytocin titration with synchronous fore water amniotomy 83.1%. Common indications for IOL included prolonged pregnancy (69.0%), and hypertensive disorders in pregnancy (15.7%). Factors influencing outcome included parity, booking status, gestational age, pre-induction cervical status and latent period interval. Conclusion: Induction of labour EBSUTH had a high success rate of 83.1%. Booking status, pre induction cervical Bishop's score ans parity amongst others significantly influenced the success rate in this study.Key Words: Induction, labour, oxytocin, misoprostol, EBSUTH, outcome.

The nurse's role during oxytocin administration.

This article addresses the importance of the nursing role in the management of oxytocin during induction/augmentation of labor. It is nurses at the bedside of laboring women who make oxytocin titration decisions based on their nursing assessments. Those decisions must be based on a sound knowledge of the pharmacologic properties of oxytocin, the physiology of uterine contractions, and the response of the woman and fetus to contractions. In addition, nurses must be aware of the standards and guidelines of care that govern their actions during induction/augmentation.

Induction of labour at term in primigravidae with low Bishop's score: a comparison of three methods

To determine which of three methods of induction of labour at term in primigravidae with a low Bishop's score is effective and safe.Random allocation to Prostin E2 and amniotomy later (Group A); low amniotomy and oxytocin titration (Group B); and intra-cervical Foley balloon overnight followed next morning by low amniotomy and oxytocin titration (Group C).Primigravidae (n = 90) in the University Hospitals, Benin City, Nigeria.(i) Time taken to achieve 3 uterine contractions in 10 min; (ii) induction-delivery interval.The mean time interval between intervention and regular uterine contractions was shortest in Group C (A vs. C, P < 0.02; A vs. B, P < 0.02). The mean induction-delivery interval was shortest in Group C (11.1 h) followed by Group B (13.9 h) and Group C (17.9 h) P < 0.05-0.001.The induction-delivery interval was shortest when using a Foley catheter for cervical ripening followed by amniotomy and oxytocin titration.

A prospective random allocation trial to compare vaginal prostaglandin E2with intravenous oxytocin for labour induction in women previously delivered by caesarean section

SummaryForty-two women requiring labour induction whose only previous delivery was by lower segment caesarean section were allocated at random to receive either vaginal prostaglandin E2, 2.5 mg followed by amniotomy, or amniotomy and intravenous oxytocin titration. There were no differences in the induction to delivery intervals or mode of delivery for the two groups; however, of six women who required a repeat caesarean section in the oxytocin group, five were for failure to establish labour compared to none out of the four in the prostaglandin group (P < 0.05): the indication for the previous caesarean section may have influenced the outcome. One case of uterine rupture occurred in the prostaglandin group after oxytocin augmentation: the risk of scar rupture remains, particularly if oxytocin augmentation is required. The results of the study suggest that prostaglandins given vaginally may provide a more effective method of induction of labour for women previously delivered by caesarean section, and a la...

Uterine Activity in Dysfunctional Labour and Target Uterine Activity to Be Aimed with Oxytocin Titration*

Uterine activity was quantified using a transducer tipped intrauterine catheter in 75 nulliparous women with dysfunctional labour. The active contraction area profiles in these women were below the median levels reported for those who had normal progress of labour from our institution. When uterine activity was augmented with oxytocin, 90.7% progressed in labour and delivered vaginally. Six patients (8%) showed poor progress despite good uterine activity and had to be delivered by caesarean section (CS) for failure to progress and signs of cephalopelvic disproportion. The pre- and post-augmentation uterine activity were similar in those who delivered vaginally or by CS and was not helpful in identifying those who had cephalopelvic disproportion. Of the 75 women who had slow progress of labour, 50 had a contraction frequency of less than 1 in 3 min whilst 25 had a minimum frequency of 1 in 3 min or more. All except one in the latter group delivered vaginally when oxytocin was titrated to achieve a contraction frequency of 1 in 2 to 2 1/2 min which were clinically judged to be adequate based on a duration greater than 40 sec. Oxytocin should be titrated to achieve a target contraction frequency of 1 in 2 to 2 1/2 min lasting greater than 40 sec to achieve good obstetric outcome in those with dysfunctional labour.

Perinatal outcome of induced labour.

SummaryFrom 1st January 1982 to 31st March 1983, 1057 consecutive cases of induced labour were studied in the University Unit, Kandang Kerbau Hospital, Singapore. The rate of induction was 9.8% and the method was artificial rupture of membranes and oxytocin titration. 559 (52.9%) were primigravidae and 498 (47.1%) were multigravidae. The leading indications were static weight or weight loss at term 356 cases (33.6%), pre‐eclampsia 240 cases (22.7%), and prolonged pregnancy 100 cases (9.5%).129 (12.3%) had amniotic fluid abnormalities at artificial rupture of membranes. 944 (89.3%) were monitored by cardio‐tocography during labour. 12.1% had suspicious fetal heart rate traces and 8.1% abnormal traces. Fetal blood sampling was used in 3% of monitored cases. There was no incidence of cord prolapse intrauterine infection, or of placental abruption.There were no intrapartum deaths and three early neonatal deaths, one of which had unsuspected lethal congenital malformations. Fifty neonates (4.7%) were admitted to the special care baby unit (SCBU), thirteen (1.2%) having required intubation. In a control group of spontaneous labours 4.6% of low risk and 8.5% of high risk normally formed neonates over 2500 grams birth weight were admitted to the SCBU. The mean Apgar score in the study group was 8.6 at 1 minute and 9.8 at 5 minutes.The emergency caesarean section rate in induced labour was 16.5% compared with 6.1% in spontaneous labour. Failed induction of labour was the indication in 42.0% of cases followed by fetal distress in 33.3% of cases.Whilst the perinatal outcome of induced labour was good, the caesarean section rate was high especially in primigravidae. More objective analysis of the degree of fetal compromise before induction of labour should reduce the induction rate and the caesarean section rate without detriment to perinatal outcome.

A simpler approach to labor induction using lipid-based prostaglandin E2 vaginal suppository

The outcome of labor induced by use of a glyceride-based vaginal suppository of prostaglandin E2 (PGE2) inserted 3 hours before amniotomy, when the cervix is favorable, has been assessed. Using 5 mg PGE2 for primigravidas and 2.5 mg for multigravidas, 63% of the former and 81% of the latter established labor and were delivered of their infants without oxytocin augmentation, allowing ambulation during early labor. No maternal complications were detected as a result of the PGE2 treatment. Compared with patients undergoing conventional induction by amniotomy and immediate oxytocin titration there was no difference in the duration of labor, with a few patients establishing labor and giving birth quickly with both induction methods. Fetal distress was less common following PGE2 treatment than following conventional induction, with three patients in each group requiring delivery by cesarean section. Cephalopelvis disproportion in the second stage of labor requiring cesarean section to deliver occurred more frequently in the prostaglandin-treated group, possibly as a result of reduced upper segment contractility in the first stage of labor with subsequent poor fetal head molding. Epidural analgesia and postpartum hemorrhge were both reduced following PGE2-induced labor.

Experience with prostaglandin F 2α (free acid) for the induction of labour

Labour was induced or augmented in 115 patients by amniotomy followed by intravenously administered prostaglandin F 2α (PGF 2α). The results were compared to those obtained retrospectively from a similar number of patients, matched for age, parity, induced and augmented labour, epidural anaesthesia and induction score; in whom labour had been induced by amniotomy followed by intravenous oxytocin titration. Both regimes were very effective, but there was a higher incidence of side effects in the patients receiving oxytocin. There was one maternal death associated with Prostaglandin infusion. Labour was also induced in a further group of 50 patients by amniotomy followed by oral PGF 2α (free acid). 42 patients (84%) were successfully induced. Vomiting and diarrhoea occurred in 22 patients (45%).

The effect of oxytocin titration on the outcome of labour following amniotomy.

SummaryAfter surgical induction of labour, the effect of the administration of oxytocin by “titration” on the outcome of labour has been studied by comparing the results for two years before and two years after instituting this method.There was no statistically significant difference in the mode of delivery or state of the fetus, but the induction‐delivery interval was considerably reduced.