Unintended Clinical Consequences of the Implementation of a Checklist-Based, Low-Dose Oxytocin Protocol

作者：Rohn Amanda E; Bastek Jamie A^*; Sammel Mary D; Wang Eileen; Srinivas Sindhu K

来源：American Journal of Perinatology, 2015, 32(4): 371-378.

DOI：10.1055/s-0034-1387932

• cesarean delivery
• chorioamnionitis
• labor dystocia
• oxytocin
• protocol

ObjectiveStandardized oxytocin protocols have been used to improve the safety and quality of obstetric care. We examined rates of chorioamnionitis and labor dystocia requiring cesarean delivery as unintended consequences of the implementation of a low-dose, checklist-based oxytocin protocol.
Study DesignWe performed a retrospective cohort study of live singleton deliveries that underwent a trial of labor in two 15-month periods, comparing outcomes in those who delivered before to after protocol implementation. Patients and outcomes were identified using a combination of electronic medical records and International Classification of Diseases, 9th Revision, Clinical Modification codes. Time trend analysis was performed to evaluate for secular trends.
ResultsA total of 8,717 women were included; 5,077 received oxytocin. Despite an unchanged rate of cesarean deliveries from before to after initiation of the protocol (15.15 vs. 14.75%, p=0.60), deliveries after protocol implementation were generally characterized by higher rates of chorioamnionitis (7.48 vs. 5.97%, p<0.001), longer median time from admission to delivery (524 vs. 462 minutes, p<0.001), more cesarean deliveries performed for labor dystocia (50.62 vs. 40.92%, p<0.001), and fewer cesarean deliveries performed for fetal distress (32.52 vs. 38.67%, p=0.02).
ConclusionLow-dose oxytocin protocols are intended to increase safety, but they may have unintended consequences related to prolonged labor, and should be studied before widespread use.

• 出版日期2015-3