Pitocin question

SIXTY ???

SIXTY????

no never have ever used a protocol like that. The most was 20 mu any place I worked.

Yeah sixty... 40 really isn't a huge surprise here, we have one doc that will go to 50mu... but I had never heard of 60... of course I've only been doing this for 6 months...

:)

seriously, 60? not 60ml's (20mu's)?

wow. i've never seen it higher than 24-26mu's

26 mu is our upper limit. You can go above it and go up to 40mu but it requires a written order from the doctor and I believe they are also transferred to high risk due to increased risk of uterine rupture. By the time you hit 40 and contractions are not adequate I doubt induction would work. Especially at 34 weeks since the oxytocin receptors in the uterus are much fewer in number at 34 weeks then they are at 40 weeks.

SIXTY? Yikes! I would have refused to increase it long before that. I once took over on a patient who had been at 36 ( I think it was, but it certainly was a number far greater than I would have agreed to do) for several hours (and then went to section.) I was fearing uterine atony and bleeding post-op, but what she (and I) both had was severe pain. I just could not get her pain under control and I believe it was her uterus just continuing to "quiver" from way too much stimulation earlier in the day. She was absolutely miserable for about 6 hours post-op. I gave her "permission" to call and tell her family to stay home and come the next day, for which she thanked me the next day.

Why do Docs think going over the protocol, both in amount and frequency of increases helps in any way? Sometimes I wonder if they've even read the same literature we read? Of course, there's always a hospital protocol, which they make and agree upon, but that seems to be in spirit only.

Had she been my patient eariler in the day

Sixty is surprising!

We will go as high as 40 when some of the privates order it, but I think this is more using pitocin to prove that a c/s is necessary.

Residents usually go up to 20mu/min.

SIXTY!! OMG. Sounds to me like this patient needed a bit of cervical ripening before using all that pit. And I would hope that there was some sort of internal monitoring going on for that much pit. There is literature that supports that high dose pit is totally ineffective....that the receptors are so saturated that it just doesn't work anymore. Why risk water intoxication and possible rupture...let alone fetal distress. 60m/u is absurd.

that protocol makes absolutely zero sense to me, for the reasons already stated.

our standing orders have us increase to 28mu/min but occasionally I have seen docs write an order to increase up to 42. But like everyone else here has said, that much more Pit doesn't really seem to help.