I am trying to find references for guidelines on what the upper limit of pitocin is for both scarred and unscarred uterus's. It is not unusual to run pitocin at more than 50-60 milliunits even on VBACs and without IUPCs. This scares the hell out of many of us, but God forbid we don't increase it at the ordered intervals, turn it down or even off!! Despite what is going on with the strip, we can be (and have been) chewed out by a doctor for not turning the pitocin up on schedule. Notice it is "a" doctor.
I am trying to gather amunition to go to the nurse manager with so we can get administration's backing on putting a limit on how high we can run pitocin. I would really love it if I could get access to those references online, but any guidance would be greatly appreciated.
May 10, '05
50-60mu/min? OMG wow. Never heard of using so much pitocin.
Our protocol calls for no greater than 20mu/min to be overriden ONLY by a separate doctor's order. And then, never, ever greater than 30mu/min will be use in any case. On VBAC's, we may not exceed 20mu/min at all
That is scary. Too much pitocin not only can hyperstimulate someone, (and yes, lead to potential for uterine rupture)---- but oxytocin abuse can cause some serious fluid balance overload (it acts like ADH) and subsequent hemodilution, which----, paradoxically,--- can lead to excessive bleeding immediately postpartum. (less clotting factors available in blood to keep bleeding in check postpartum).
I know AWHONN has addressed the use of oxytocins time and again and I would say that is the place to start. I am sure if you search, you can find some articles discussing the abuse of oxytocin and hyperstimulation and fluid volume overload.
for your reference. I also know Michelle Murray has discussed pitocin use ad nauseum. Perhaps you can find some of her works or attend a conference? She will scare the poop out of you.
Also, take this situation to your PERINATAL COMMITTEE and Chief of OB, risk management team, as well as hospital CEO, if need be, ASAP---esp if this is just ONE doctor doing this. The guy or gal is very, very dangerous.
Last edit by SmilingBluEyes on May 10, '05