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Alerts

Oxytocin Shortage: Recommended Alternative Strategies

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SUMMARY:

Oxytocin is a frequently used medication on labor and delivery units. While there are other drugs that can be used for various procedures, oxytocin remains central to obstetric practice. Currently, there is a national shortage of oxytocin. ACOG recommends alternative strategies with an understanding that multi-disciplinary teams will be required to implement alternatives until the shortage is resolved.

Recommended Strategies to Consider

Antepartum

  • Induction schedules
    • Review and develop a hierarchy for scheduled and unscheduled inductions
  • PPH risk analysis
    • Consider specific indications and contraindications to uterotonics

Intrapartum

  • Admission criteria for active labor
    • Example: Consider cervical dilation ≥4 cm
  • Other cervical ripening agents for IOL
    • Example: Balloon with misoprostol vs concomitant oxytocin
  • Active management of labor
    • Enhance induction with nonpharmacologic interventions, e.g., amniotomy
  • PPH
    • Plan ahead with updated individual risk stratification
    • Stratify and update individual risk for postpartum hemorrhage
  • Retain the intrapartum infusion bag for the same patient in case of hemorrhage in the postpartum period

Postpartum

  • PPH prophylaxis
    • Oxytocin 10 U IM
    • Alternative uterotonics depending on patient risk factors (one-time dosing)
      • Methylergonovine | 15-methyl prostaglandin F2α | Misoprostol
  • Active PPH
    • Alternative uterotonics (two doses)
      • Methylergonovine | 15-methl prostaglandin F2α | Misoprostol
    • Move on to oxytocin infusion after alternative medications have been administered

Note: Consider TXA if initial therapy fails

Learn More – Primary Sources:

ACOG FAQs: Oxytocin Shortage

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Related ObG Topics:

Postpartum Hemorrhage – Medications to Treat Uterine Atony 
Postpartum Hemorrhage Prophylaxis: The World Health Organization Recommendations
Secondary Analysis of ARRIVE RCT: The Association Between Amniotomy During Induction and Cesarean Delivery

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