Implementation of a conservative checklist- based protocol for oxytocin administration: maternal and newborn outcomes

Objective: The purpose of this study was 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: This was 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 2 groups were demographically similar. For the pre-and postprotocol groups, the mean time of infusion to delivery was 8.5 +/- 5.3 hours versus 8.2 +/- 4.5 hours (NS), the maximum oxytocin infusion rate was 13.8 +/- 6.3 mU/min versus 11.4 +/- 3 6.1 mU/min (P = .003) and the cesarean delivery rate was 15% versus 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 = .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. Conclusion: Implementation of a specific and conservative check-list-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. Cesarean delivery rate declined system-wide following implementation of this protocol. Newborn outcome also appears to be improved.