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Review
. 2020 Jul 28;15(7):e0227941.
doi: 10.1371/journal.pone.0227941. eCollection 2020.

How much synthetic oxytocin is infused during labour? A review and analysis of regimens used in 12 countries

Deirdre Daly  1 , Karin C S Minnie  2 , Alwiena Blignaut  2 , Ellen Blix  3 , Anne Britt Vika Nilsen  4 , Anna Dencker  5 , Katrien Beeckman  6 , Mechthild M Gross  7 , Jessica Pehlke-Milde  8 , Susanne Grylka-Baeschlin  8 , Martina Koenig-Bachmann  9 , Jette Aaroe Clausen  10 , Eleni Hadjigeorgiou  11 , Sandra Morano  12 , Laura Iannuzzi  13 , Barbara Baranowska  14 , Iwona Kiersnowska  15 , Kerstin Uvnäs-Moberg  16
Affiliations
Review

How much synthetic oxytocin is infused during labour? A review and analysis of regimens used in 12 countries

Deirdre Daly et al. PLoS One. .

Abstract

Objective: To compare synthetic oxytocin infusion regimens used during labour, calculate the International Units (IU) escalation rate and total amount of IU infused over eight hours.

Design: Observational study.

Setting: Twelve countries, eleven European and South Africa.

Sample: National, regional or institutional-level regimens on oxytocin for induction and augmentation labour.

Methods: Data on oxytocin IU dose, infusion fluid amount, start dose, escalation rate and maximum dose were collected. Values for each regimen were converted to IU in 1000ml diluent. One IU corresponded to 1.67μg for doses provided in grams/micrograms. IU hourly dose increase rates were based on escalation frequency. Cumulative doses and total IU amount infused were calculated by adding the dose administered for each previous hour. Main Outcome Measures Oxytocin IU dose infused.

Results: Data were obtained on 21 regimens used in 12 countries. Details on the start dose, escalation interval, escalation rate and maximum dose infused were available from 16 regimens. Starting rates varied from 0.06 IU/hour to 0.90 IU/hour, and the maximum dose rate varied from 0.90 IU/hour to 3.60 IU/hour. The total amount of IU oxytocin infused, estimated over eight hours, ranged from 2.38 IU to 27.00 IU, a variation of 24.62 IU and an 11-fold difference.

Conclusion: Current variations in oxytocin regimens for induction and augmentation of labour are inexplicable. It is crucial that the appropriate minimum infusion regimen is administered because synthetic oxytocin is a potentially harmful medication with serious consequences for women and babies when inappropriately used. Estimating the total amount of oxytocin IU received by labouring women, alongside the institution's mode of birth and neonatal outcomes, may deepen our understanding and be the way forward to identifying the optimal infusion regimen.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Dose rate increase over an eight-hour period.
Fig 2
Fig 2. Total oxytocin dose (IU) infused over an eight-hour period.
See this image and copyright information in PMC

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