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Labor

Poster Session 3

(840) How Much Oxytocin Do We Give? Cumulative Doses for Labour Acceleration

Wednesday, February 14, 2024
8:30 AM – 10:00 AM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective:

Recent publications call for more detailed data regarding the cumulative doses of oxytocin (CDOs) given over the course of labour, to increase our understanding of the drug. We aimed to evaluate the CDOs given for labour acceleration with a high dose regimen (HDR), to compare these to CDOs possible within low dose regimens (LDRs), and to evaluate if HDRs translate to high CDOs.

Study Design:

We conducted a retrospective cohort study of all Robson Group 1 patients over a one-year period who had been commenced on oxytocin for labour acceleration (augmentation) in the first stage (n=414). Labours were accelerated if progress was < 1cm/hour over a two-hour period. A HDR of oxytocin was given, commencing at 5mU/min and increasing by 5mU every 15 minutes to a maximum of 30mU/min. CDOs were manually calculated to account for all dose titrations, duration of each titration and labour duration. The CDOs given with our HDR were then compared to those permissible within a LDR, commencing at 2mU/min and increasing by 2mU every 30 mins to a maximum of 15mU/min.

Results:

CDOs spanned a wide, right skewed range (75 - 17,325mU) when recorded as a continuous variable. The mean (SD) CDO for our study cohort was 3006mU (±2992mU). 0.9% (4/414) of the population reached the maximum CDO permitted by the HDR. 57.2% (237/414) of the CDOs given were within the range permitted by LDRs. At 8-hours of oxytocin acceleration the mean (SD) CDO was 4468mU (±2729mU), less than 1/3 of the maximum permitted dose of 13,280mU over that duration.

Conclusion:

Previous studies of CDOs comment on maximum permitted doses of oxytocin within HDR and LDRs, rather than true doses given. Our study shows that using a HDR, the true CDO given falls within the range of doses permitted by LDRs for the majority of cases. We report a mean CDO of 3006mU, which is lower than previous studies of with LDRs which quote 3437mU as the mean CDO for Group 1 labour acceleration. We conclude that CDOs reflect an institutions readiness to downward titrate, and safe, judicious use of oxytocin. Without knowledge of CDOs, debate regarding HDR and LDR is trivial.