PLACE LABEL HERE
PITOCIN (OXYTOcin) Induction / Augmentation
Of Labor Orders
The following orders will be implemented. Orders with a “q” are choices and are NOT implemented unless checked.
Initial all handwritten order modifications and the bottom of each page when indicated (multipage).
INDICATION FOR INDUCTION: q N/A - augmentation
q Abruptio placentae / q Premature rupture of membranes (PROM)q Chorioamnionitis / q Postterm (> 41.0 weeks)
q Gestational hypertension / q Maternal medication condition (e.g., diabetes, chronic pulmonary disease, renal disease, chronic hypertension, antiphospolipid syndrome, etc.)
q Preeclampsia/eclampsia/
HELLP / q Fetal compromise (e.g., severe IUGR, oligohydramnios, isoimmunization, abnormal BPP, etc.)
q Elective:______/ q Other:______
q INDUCTION Estimated Gestational Age: ______ / PELVIC EXAMINATION
Confirmation of Term Gestation, if elective:
q Fetal heart tones have been documented for 20 weeks by nonelectronic fetoscope or for 30 weeks by Doppler.
q It has been 36 weeks since a positive serum or urine hCGpregnancy test was performed by a reliable lab.
q An ultrasound measurement of the crown/rump length, obtained at 6-12 weeks, supports a gestational age of at least 39 weeks.
q An ultrasound obtained at 13-20 weeks confirms the gestational age of at least 39 weeks determined by clinical history and physical examination.
q Amniocentesis and documentation of fetal maturity. / Pelvis: q Adequate q ______
Cervical Exam:
Position: qPosterior qIntermediate qAnterior
Consist: q Firm qIntermediate qSoft
Dilation: ______
Effacement:______
Station: ______
q AUGMENTATION Estimated Fetal Weight: ______
1. Follow Labor Admission Orders (seq # 9044) and Normal Vaginal Delivery Clinical Pathway
2. External fetal monitoring for 20 min prior to starting Pitocin (oxytocin). For Category II or III FHR patterns, hold Pitocin (oxytocin) and notify physician/CNM
3. Maternal VS, FHR, and uterine activity per policy # 7007-08
SCHEDULED MEDICATIONS:
4. Pitocin (oxytocin)15 units in NS 250 ml, piggyback through an infusion pump to the mainline IV
Start Pitocin (oxytocin) infusion at 2 milliunits/min IV.
Increase by 2 milliunits/min q 30 min until 2-5 regular uterine contractions q 10 min.
If 20 milliunits/min is reached, perform SVE and notify physician/CNM
OR
q Start Pitocin (oxytocin) infusion at q 1 milliunit/min OR q 2 milliunits/min
Increase by q 1 OR q 2 milliunits/min q 30 min until 2-5 regular uterine contractions q 10 mins.
If 20 milliunits/min is reached, perform SVE and notify physician/CNM
5. If uterine tachysystole, implement Pitocin (oxytocin) Induced Tachysystole protocol (see reverse)
______
Date Time Physician Signature PID Number
Copy to pharmacy
*1-6* FORM 1-6 REV. 12/2015 Page 1 of 1
Pitocin (oxytocin) Induction / Augmentation
of Labor Orders
Reference Page
Protocol for Pitocin (oxytocin)-Induced Tachysystole (7007-08)
Tachysystole: More than 5 contractions in 10 minutes, averaged over a 30-minute
With Category I (Normal) FHR Tracing
· Maternal repositioning (left or right lateral position)
· IV fluid bolus of at least 500 mL lactated Ringer’s solution
· If uterine activity has not returned to normal after 10-15 minutes
o Reduce oxytocin rate by at least half
o If uterine activity has not returned to normal after 10-15 additional minutes
§ Discontinue oxytocin until uterine activity is no more than five contractions in 10 minutes
o If patient is in the latent phase of labor (less than 4 cm dilated) and having mild (to palpation) high-frequency, low-amplitude contractions, contact physician/CNM to determine plan of care. In this clinical scenario, it may be acceptable to continue titration of Pitocin (oxytocin).
o If patient has an IUPC in place, and documented Montevideo units are less than 250 MVUs, contact physician/CNM to determine plan of care. In this clinical scenario, it may be acceptable to continue titration of Pitocin (oxytocin).
With Category II (Indeterminate) or Category III (Abnormal) FHR Tracing
· Discontinue Pitocin (oxytocin)
· Maternal repositioning (left or right lateral position)
· IV fluid bolus of at least 500 mL lactated Ringer’s solution
· Oxygen at 10 L/min via nonrebreather facemask (discontinue as soon as possible based on fetal response)
· Give terbutaline 0.25 mg SQ if:
o Prolonged deceleration
o No response after 10-15 minutes
Resumption of Pitocin (oxytocin) After Resolution of Tachysystole
· If Pitocin (oxytocin) has been discontinued for less than 30 minutes, there is a Category I tracing, and contractions are no more than five in 10 minutes
o Resume Pitocin (oxytocin) at no more than half the rate that was being given at the time of tachysystole
o Resume titration as ordered
· If Pitocin (oxytocin)has been discontinued for at least 30 minutes, there is a Category I tracing, and contractions are no more than five in 10 minutes
o Resume Pitocin (oxytocin) at initial dose ordered
o Resume titration as ordered
FORM 1-6 REV. 12/2015 Reference Page