Implementation of a Conservative Checklist-Based Protocol for Oxytocin Administration: Maternal and Newborn Outcomes in a Multi-Hospital System

Objective To examine the effects of a conservative and specific, checklist based protocol for oxytocin administration on maternal and newborn outcome. The protocol was based on maternal and fetal response to oxytocin rather than infusion rate.

Study Design

A retrospective chart review and data extraction of the last 100 patients receiving oxytocin before implementation of the protocol, and the first 100 patients receiving oxytocin after protocol implementation. A retrospective chart review and data extraction of the last 100 patients receiving oxytocin before implementation of the protocol, and the first 100 patients receiving oxytocin after protocol implementation. A retrospective chart review and data extraction of the last 100 patients receiving oxytocin before implementation of the protocol, and the first 100 patients receiving oxytocin after protocol implementation. A retrospective chart review and data extraction of the last 100 patients receiving oxytocin before implementation of the protocol, and the first 100 patients receiving oxytocin after protocol implementation. A retrospective chart review and data extraction of the last 100 patients receiving oxytocin before implementation of the protocol, and the first 100 patients receiving oxytocin after protocol implementation. A retrospective chart review and data extraction of the last 100 patients receiving oxytocin before implementation of the protocol, and the first 100 patients receiving oxytocin after protocol implementation. A retrospective chart review and data extraction of the last 100 patients receiving oxytocin before implementation of the protocol, and the first 100 patients receiving oxytocin after protocol implementation.

Results
The two groups were demographically similar. For the pre- and post-protocol groups, the mean time of infusion to delivery was 8.5 +/- 5.3 hours vs. 8.2 +/- 4.5 hours (NS), the maximum oxytocin infusion rate was 13.8 +/- 6.3 mU/min vs. 11.4 +/- 6.1 mU/min (p=0.003) and the cesarean delivery rate was 15% vs. 13% (NS.) Every index of newborn outcome was improved in the post-protocol group, but these differences did not individually reach statistical significance. However, newborns with any index of adverse outcome were significantly fewer in the post protocol group (31 vs. 18, p = 0.049). System-wide implementation of this program was associated with a decline in the rate of primary cesarean delivery from 23.6% in 2005 to 21.0% in 2006.

Conclusions

Implementation of a specific and conservative checklist- based protocol for oxytocin infusion based on maternal and fetal response results in a significant reduction in maximum infusion rates of oxytocin without lengthening labor or increasing operative intervention. Newborn outcome also appears to be improved.