Deviation in the Standard of Care During Pitocin (Oxytocin) Management

Evaluate breaches in the standard of care to determine whether or not there has been a Deviation in the Standard of Care During Pitocin (Oxytocin) Management

Answer the following questions to find out if the standard of care was followed for your case.

  • With which of the following indications for Oxytocin (Pitocin) administration did the patient present? (Choose all that apply)
    Maternal diabetes
    Pre-eclampsia/Pregnancy induced hypertension
    Premature rupture of membranes
    Uterine inertia
    Post-term pregnancy
    Intra-uterine growth restriction (IUGR)
    HELLP (hemolysis, elevated liver enzymes and low platelet count) syndrome
    Chorioamnionitis
    Fetal compromise
    Incomplete/inevitable abortion
    Postpartum hemorrhage
    None of the above
    Not elicited
    Answer unknown
    Why is this important?
    Pitocin is indicated to produce uterine contractions during the third stage of labor and to control postpartum bleeding or hemorrhage.
    (2005) 32 EOGCNA 2 181-200

  • Was a medical history obtained? Why is this important?
    Answer this question

  • Was a physical examination performed? Why is this important?
    Answer this question

  • Was a pelvic examination performed? Why is this important?
    Answer this question
    The pelvic examination begins by inspecting the perineum, vagina, and cervix. Close inspection is required to identify any herpetic lesions or other vaginal or cervical lesions.
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  • Was Pitocin used for elective induction of labor? Why is this important?
    Answer this question
    In 2007, the Food and Drug Administration (FDA) issued a warning which states that Pitocin is not indicated for elective induction of labor (a woman with no medical indication for induction of labor).
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  • Was fetal pulmonary maturity established prior to inducing labor with Pitocin? Why is this important?
    Answer this question
    The American College of Obstetricians and Gynecologists (ACOG) recommends that the gestational age of the fetus be at least 39 weeks, or that fetal lung maturity be assessed and deemed sufficient before induction of labor with Pitocin.
    (2005) 32 EOGCNA 2 181-200

  • Was the status of the cervix assessed prior to labor induction? Why is this important?
    Answer this question
    Cervical ripening is the first component to labor induction. If the cervix is not sufficiently dilated, then drugs or mechanical cervical dilators should be used to ripen the cervix before labor is induced.
    (2005) 32 EOGCNA 2 181-200

  • What was the patient’s Bishop Score? Why is this important?
    Answer this question
    Clinical assessment of the cervix enables prediction of the likely outcome of induction of labor. The most commonly used method of assessment is the Bishop score or by modification of this score. This cervical score involves clinical examination of the cervix.
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  • Which of the following contraindications were not ruled out prior to induction with Pitocin? (Choose all that apply) Why is this important?
    Answer this question
    The individual patient and clinical situation must be considered in determining when induction of labor is contra-indicated. Generally, the contraindications to labor induction are transverse fetal lie, vasa previa, umbilical cord prolapse, and active genital herpes.
    (2005) 32 EOGCNA 2 181-200

  • Was Pitocin administered to a patient with a history of previous cesarean sections? Why is this important?
    Answer this question
    History of previous cesarean sections is associated with an increased risk for uterine rupture.
    (2008) 35 ECLPER 3 491-504

  • Was a senior obstetrician’s approval obtained for Pitocin use in a multiparous women or scarred uterus? Why is this important?
    Answer this question
    Particular care should be taken in multiparous women and those with a uterine scar. In such cases, Pitocin should be used only with the approval of a senior obstetrician.
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  • Were facilities for immediate caesarean section / intrauterine resuscitation made available before induction of labor? Why is this important?
    Answer this question
    Pitocin should not be used in labor where there are no facilities for an immediate caesarean section.
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  • Was the patient counseled regarding the risks and benefits of the induction procedure? Why is this important?
    Answer this question
    All patients should be counseled regarding the indications for induction, the expected results, the alternatives, and the possible adverse effects, including the increased risks for cesarean section, uterine hyperstimulation, and fetal distress.
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  • Was an informed consent obtained? Why is this important?
    Answer this question
    The laws of most states require that clinicians obtain informed consent before providing treatment.
    (2011) 23 EOMSCA 3 475-484

  • Was fetal monitoring performed before the administration of Pitocin? Why is this important?
    Answer this question
    A fetal monitoring is indicated before beginning the Pitocin infusion. Monitoring of Fetal Heart Rate (FHR) and uterine activity should continue throughout the administration of Pitocin.
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  • Was amniotomy performed prior to administration of Pitocin? Why is this important?
    Answer this question
    Pitocin is largely ineffective before amniotomy. so the appropriate sequence of use is prostaglandin or transcervical Foley catheter followed by amniotomy and then Pitocin.
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  • Which of the following standardized infusion protocols of Pitocin were not followed? (Choose all that apply) Why is this important?
    Answer this question
    Cervical ripening is the first component to labor induction. If the cervix is not sufficiently dilated, then drugs or mechanical cervical dilators should be used to ripen the cervix before labor is induced.
    (2005) 32 EOGCNA 2 181-200

  • Was a checklist for Pitocin administration followed? Why is this important?
    Answer this question
    Checklists for Pitocin have been shown to reduce the maximal infusion rate without lengthening labor or increasing operative interventions, and to reduce the rate of adverse outcomes in newborns.
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  • Which of the following were not continuously monitored and recorded in the medical chart during Pitocin infusion? (Choose all that apply) Why is this important?
    Answer this question
    The dosage, the rate of the Pitocin infusion, the uterine contraction duration and frequency, and the fetal heart rate pattern in relationship to the uterine contractions, must be continuously monitored and documented in the medical record.
    (2007) 34 ECLPER 2 345-360