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Evidenced Based Practice: Oxytocin (pitocin) Use during Labo
Transcript of Evidenced Based Practice: Oxytocin (pitocin) Use during Labo
What is Pitocin?
Pitocin is the synthetic form of the natural hormone, oxytocin
Oxytocin is a major hormone secreted in childbirth
It is secreted from the posterior aspect of the pituitary gland in the brain
Oxytocin stimulates the smooth muscle in the uterus
It increases the strength, frequency, and duration of contractions
Standards in Labor Augmentation
"Oxytocin in high versus low doses for augmentation of delayed labor" is a review that compared 4 studies with 644 women.
The authors reviewed trials comparing high doses of pitocin versus low doses of pitocin in delayed labor for augmentation.
Standards in Postpartum Use
"Prophylactic oxytocin for the third stage of labor" is a review that compared 20 studies with 10,806 women.
The authors reviewed trials that compared the effectiveness of prophylactic pitocin in the third stage of labor to prevent postpartum hemorrhage and other complications.
Third stage- time from delivery of baby to delivery of the placenta.
Nurses are patient's advocates!
They can use the standards previously mentioned to advocate for the best care for their patients.
Standards in Labor Induction
"Oxytocin for induction of labor" is a review that compared 61 trials with 12,819 women.
The authors reviewed trials that compared the use of pitocin to induce labor versus "expectant management" or other drugs to induce.
"Expectant management" is waiting for labor to start on its own.
The authors of the review found:
When pitocin was given to women, more women delivered vaginally within 24 hours.
There was an increase in the use of epidural analgesia.
Fewer women expressed dissatisfaction with pitocin.
However, when pitocin was compared with other drugs (prostaglandins), the prostaglandins allowed for more deliveries within 24 hours than when using pitocin.
The authors concluded:
Prostaglandins should be used to induce labor rather than pitocin.
Pitocin may increase the need for additional interventions during labor
The authors found:
pitocin at any dose decreases postpartum hemorrhage of greater than 500 mL.
Pitocin in the third stage also decreases the need for therapeutic "uterotonics."
Alfirevic Z, Kelly AJ, Dowswell T. Intravenous oxytocin alone for cervical ripening and induction of labour. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD003246. DOI: 10.1002/14651858.CD003246.pub2
The authors of the review found:
Higher doses of pitocin (about 4 mU/minute) showed a reduced length of labor.
It also showed a decrease in the number of cesarean section deliveries and an increase in spontaneous vaginal births.
The authors concluded that although the studies show that higher doses of pitocin decrease the length of labor, decrease the number of c-section deliveries, and increase the chance for spontaneous vaginal delivery, there is not enough evidence to recommend that high doses be used routinely.
Kenyon S, Tokumasu H, Dowswell T, Pledge D, Mori R. High-dose versus low-dose oxytocin for augmentation of delayed labour. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No.: CD007201. DOI: 10.1002/14651858.CD007201.pub3
The authors concluded that providers should give women prophylactic oxytocin during the third stage of labor.
It should be given via intravenous route or via intramuscular route.
Westhoff G, Cotter AM, Tolosa JE. Prophylactic oxytocin for the third stage of labour to prevent postpartum haemorrhage. Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD001808. DOI: 10.1002/14651858.CD001808.pub2
Murray, S. S., & McKinney, E. S. (2010). Foundations of Maternal-Newborn and Women’s Health Nursing. (5th ed.). Maryland Heights, MO: Saunders: Elsevier.