June 25, 2009

Hospital’s Oxytocin Protocol Change Sharply Reduces Emergency C-Section Share

One of my fellow chidlbirth advocates turned me onto an article about the correlation of pitocin usage and emergency cesareans. Interestingly, as the usage of pitocin increases (According to the authors of Williams Obstetrics, 81% of the women who gave birth in the hospital received pitocin during their labors.) as does the national cesarean rate. The US is currently hovering around 30% of births born via cesarean section.

The article and study brings hope that if the use (or abuse?) of pitocin is decreases so would the number of c-sections.

Hospital’s Oxytocin Protocol Change Sharply Reduces Emergency C-Section Share
By Betsy Bates
Elsevier Global Medical News link to full story

Conferences in Depth
June 22, 2009

CHICAGO (EGMN) – The modification of the oxytocin infusion protocol at a
large university-affiliated community hospital nearly halved the number of
emergency cesarean deliveries over a 3-year period, reported Dr. Gary

As oxytocin utilization declined from 93.3% to 78.9%, emergency cesarean
deliveries decreased from 10.9% to 5.7%, Dr. Ventolini said at the annual
meeting of the American College of Obstetricians and Gynecologists.

Other birth outcomes improved as well at an 848-bed community hospital that
serves as the primary teaching hospital of the Boonshoft School of Medicine
at Wright State University in Dayton, Ohio.

These included significant declines in emergency vacuum and forceps
deliveries and a sharp reduction in neonatal ICU team mobilization for signs
of fetal distress (P = .0001 in year 3 compared with year 1).

More and more data are showing us that we are using too much oxytocin too
,” Dr. Ventolini, professor and chair of obstetrics and gynecology at
the university, said in an interview.
“Our pivotal change was to modify the oxytocin infusion from 2 by 2 units
every 20 minutes to 1 by 1 unit every 30 minutes. And we see the results,”
he said.

Outcomes of 14,184 births from 2005, 2006, and 2007 were retrospectively
analyzed to determine any impact of the change in an oxytocin protocol
implemented in 2005. Patient characteristics were similar in all three
calendar years.

The most profound changes were in emergency deliveries, including caesarean
deliveries, vacuum deliveries (which dropped from 9.1% to 8.5%), and forceps
deliveries (which fell from 4% to 2.3%).

The overall cesarean section rate remained unchanged, as did the rates of
cord prolapse, preeclampsia, and abruption.

Dr. Ventolini cited a recent article in the American Journal of Obstetrics
and Gynecology
that suggests guidelines for oxytocin use, including
avoidance of dose increases at intervals shorter than 30 minutes in most
situations (Am. J. Obstet. Gynecol. 2009;200:35.e1-.e6).

Dr. Ventolini and his associates reported no financial conflicts of interest
relevant to the study.



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