Implementation of a conservative checklist-based protocol for oxytocin administration: maternal and newborn outcomes

Am J Obstet Gynecol. 2007 Nov;197(5):480.e1-5. doi: 10.1016/j.ajog.2007.08.026.


Objective: The purpose of this study was to examine the effects of a conservative and specific checklist-based protocol for oxytocin administration on maternal and newborn outcome. The protocol was based on maternal and fetal response to oxytocin rather than infusion rate.

Study design: This was a retrospective chart review and data extraction of the last 100 patients receiving oxytocin before implementation of the protocol and the first 100 patients receiving oxytocin after protocol implementation.

Results: The 2 groups were demographically similar. For the pre- and postprotocol groups, the mean time of infusion to delivery was 8.5 +/- 5.3 hours versus 8.2 +/- 4.5 hours (NS), the maximum oxytocin infusion rate was 13.8 +/- 6.3 mU/min versus 11.4 +/- 6.1 mU/min (P = .003) and the cesarean delivery rate was 15% versus 13% (NS). Every index of newborn outcome was improved in the post-protocol group, but these differences did not individually reach statistical significance. However, newborns with any index of adverse outcome were significantly fewer in the post protocol group (31 vs 18, P = .049). System wide implementation of this program was associated with a decline in the rate of primary cesarean delivery from 23.6% in 2005 to 21.0% in 2006.

Conclusion: Implementation of a specific and conservative checklist-based protocol for oxytocin infusion based on maternal and fetal response results in a significant reduction in maximum infusion rates of oxytocin without lengthening labor or increasing operative intervention. Cesarean delivery rate declined system-wide following implementation of this protocol. Newborn outcome also appears to be improved.

MeSH terms

  • Adult
  • Cesarean Section / statistics & numerical data
  • Clinical Protocols*
  • Female
  • Fetus / drug effects*
  • Humans
  • Infusions, Intravenous
  • Labor, Induced*
  • Oxytocics / administration & dosage*
  • Oxytocin / administration & dosage*
  • Pregnancy
  • Pregnancy Outcome*
  • Retrospective Studies


  • Oxytocics
  • Oxytocin