OB Guideline 17: Augmentation of Labor

Labor may be augmented with the use of oxytocin, amniotomy, or both.

Prior to the Augmentation of Labor

The following criteria should apply:

• patient was evaluated and the pelvic exam documented;
• an indication for augmentation of labor, e.g., arrest or protraction of labor, prolonged latent phase of labor, hypotonic uterine contraction pattern;
• no contraindications to augmentation of labor;
• the fetal presentation is cephalic; and
• the absence of a Category III FHR tracing.

Explain to the patient the planned procedures and/or medications, including risks, benefits, and alternatives, and document the patient’s agreement in the medical record.

After the Initiation of Oxytocin

(See Guideline 16.) The patient should be monitored for effect, including:

• contractions either electronically or by palpation, with a goal of avoiding uterine tachysystole (hyperstimulation);
• fetal status (continuous electronic fetal monitoring is mandated, brief interruptions are acceptable);
• the progress of the patient’s labor;
• monitoring the dose of oxytocin (adequate documentation of clinical reasoning is required and intrauterine pressure (IUPC) may be considered when oxytocin infusion rates rise above 20 mu/min); and
• when external monitoring is problematic, consider applying the IUPC for monitoring uterine contractions. All of these monitoring activities should be recorded in the medical record.

Institutional Responsibility

Each obstetrical unit shall develop guidelines for the use of oxytocin (see Guideline 16). The institution is responsible for ensuring that enough controlled infusion devices for administration of oxytocin are maintained and available to meet the needs of the patient population.