Oxytocin augmentation: Poison or potion in the multipara?

Abstract

Oxytocin is one of the most commonly used drugs in obstetric practice but it is also the drug associated with the most preventable adverse events in childbirth. In this review we look at the use of oxytocin augmentation in the multigravida. We look at the concept of whether the multigravida is different to the primigravida. We provide a differential diagnosis for poor progress in the multigravida and look at the use of the partogram. Oxytocin recommended regimens are discussed and we look at how one can measure the effects of oxytocin. We summarize the evidence for the use of oxytocin in augmentation of the multigravida and then provide strategies to avoid problems if oxytocin is used in the multigravid patient. We conclude that the multigravida is very different to the primigravida and that use of oxytocin for augmentation in the multigravida should be strongly discouraged. If used, one should seriously consider the risks associated with oxytocin augmentation in the multigravida which includes uterine rupture. Use needs to be decided on a senior consultant level and it should only be used with continuous fetal monitoring, intrauterine pressure monitoring and only after all other causes of poor progress in the multigravida have been excluded. Consent, with explanation of all the risks associated with augmentation, should be obtained from the mother before augmentation is initiated. If oxytocin is going to be used for augmentation in the multigravida there must be a standardized protocol, there must be a doctor on site who is able to perform emergency caesarean section and who is available to respond to all emergencies. A low-dose, low-frequency dosing regimen should be used with weaning to the lowest dose necessary to maintain contractions.