## Oxytocin Dosing for Labor Induction **Key Point:** The maximum recommended dose of intravenous oxytocin is 40 mIU/min, with dose increments of 1 mIU/min every 15 minutes until adequate uterine contractions are achieved (3 contractions in 10 minutes, each lasting ≥40 seconds). ### Standard Oxytocin Induction Protocol | Parameter | Value | |-----------|-------| | Starting dose | 0.5–1 mIU/min | | Dose increment | 1 mIU/min | | Interval between increments | 15 minutes | | Maximum dose | 40 mIU/min | | Target contraction pattern | 3 contractions/10 min, ≥40 sec duration | | Adequate labor | 2–3 contractions/10 min | **High-Yield:** Slow, incremental dosing (1 mIU/min every 15 minutes) reduces the risk of uterine hyperstimulation, water intoxication, and maternal/fetal complications. **Mnemonic:** **SLOW OXYTOCIN** = Start Low, Increase Slowly, Wait 15 minutes, Observe response, Titrate to effect, Avoid rapid escalation, Cease at 40 mIU/min. **Clinical Pearl:** Adequate labor is defined as 2–3 contractions per 10 minutes with adequate intensity and duration. Hyperstimulation is defined as >5 contractions in 10 minutes or contractions lasting >90 seconds. **Warning:** Rapid escalation of oxytocin (>5 mIU/min increments or intervals <15 minutes) increases the risk of: - Uterine hyperstimulation and tetany - Placental abruption - Uterine rupture - Fetal hypoxia and bradycardia - Maternal water intoxication (hyponatremia) with prolonged high-dose infusions ### Contraindications to Oxytocin Induction - Previous uterine scar (classical cesarean section) - Placenta previa or vasa previa - Transverse lie - Cord prolapse - Active genital herpes infection - Suspected placental abruption
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