Last month, an in depth study on the labor induction drug Pitocin was presented at the annual meeting of the American College of Obstetricians and Gynecologists (ACOG). According to the research, induction and augmentation of labor with oxytocin (Pitocin) may not be as safe for full-term newborns as previously believed. Although many studies have shown the adverse effects oxytocin can have when used for labor induction, this study is very unique in its design.
Oxytocin is given intravenously to initiate labor when a pregnant woman is past her due date. In addition, it is used to speed up labor by increasing the frequency, duration, and intensity of uterine contractions.
Primary researcher Michael S. Tsimis, M.D., and fellow researchers at Beth Israel Medical Center studied more than 3000 women delivering full term infants between 2009 and 2011 who had deliveries induced or augmented by oxytocin. The researchers used the Adverse Outcome Index, one of several tools used to measure unexpected outcomes in the perinatal setting and to track obstetric illness and death rates.
The study found that induction and augmentation of labor with oxytocin was an independent risk factor for unexpected admission to the neonatal intensive care unit (NICU) lasting more than 24 hours for full term infants. Augmentation with oxytocin also correlated with Apgar scores of fewer than 7 at 5 minutes. An Apgar score is a test that evaluates a newborn baby’s physical condition at 1 and 5 minutes after birth based on appearance (skin color), pulse, grimace response (also known as “reflex irritability”), activity and muscle tone, and respiration (breathing rate and effort). A baby who scores 8 and above is usually considered to be in good health and a baby scoring 7 or below will require closer observation, and the low score may raise concerns as to the general health of the newborn.
Commenting on the study, Dr. Tsimis said, “As a community of practitioners, we know the adverse effects of Pitocin from the maternal side, but much less so from the neonatal side. These results suggest that Pitocin use is associated with adverse effects on neonatal outcomes. It underscores the importance of using valid medical indications when Pitocin is used.”
The study indicates that oxytocin may not be as safe as once thought. Dr. Tsimis stated that there should be a more systematic and conscientious approach to the indications for its use.
The Dangers of Pitocin/Oxytocin
Indeed, oxytocin should be used conservatively, and it should only be used for emergency induction of labor. Oxytocin can be unpredictable, and one of the serious risks it poses to the mother and baby is a condition characterized by hyperstimulation and hypertonicity of the uterus.
When this occurs, the frequency and strength of uterine contractions are increased so much that the uterus does not have much (or any) time to relax and recharge with a fresh supply of oxygen-rich blood for the baby. In this condition, the uterus has an increased resting tone. Specifically, during hyperstimulation, the uterus is in a hypertonic state, which means that contractions are so frequent, it is as if the uterus is almost continuously contracted. When the uterus is contracted, it pushes against and compresses the vessels that supply blood to the baby through the umbilical cord. This can cause the supply of oxygen-rich blood to the baby to become severely reduced. The baby can then become oxygen deprived, with her oxygen supply becoming progressively lower as hyperstimulation and hypertonicity continue. Prolonged oxygen deprivation in a baby can cause brain cell death and permanent injury, such as hypoxic ischemic encephalopathy (HIE) and cerebral palsy. When hyperstimulation and hypertonicity occur, the baby must usually be delivered by an emergency C-section.
Standards of Care for Pitocin/Oxytocin Administration
In light of the new research and due to the potential for such serious consequences for the baby, it is crucial that physicians use oxytocin/Pitocin only as indicated. Medical standards of care must be followed. These standards include the following:
- Oxytocin is indicated when continuing the pregnancy is thought to be associated with greater maternal or fetal risk than intervention to deliver the pregnancy. In addition, there must be no contraindications to vaginal birth.
- The mother should be given a Bishop Score. This is a scoring system used to help determine if the induction of labor will be successful.
- Oxytocin should be started at relatively low doses.
- Proper fetal monitoring must be utilized.
- Contractions are considered acceptable if the contractions have a consistent strength and rate or they have a consistent pattern of 1 contraction every 2-3 minutes lasting 80-90 seconds and are strong.
- Once acceptable contractions have been met, there is no justification for additional increases in oxytocin dose.
- Oxytocin should be aggressively titrated to the lowest dose compatible with sustained levels of appropriate uterine activity.
- Delivery by C-section (not more oxytocin) is indicated when acceptable levels of uterine activity have been met at the lowest dose, but the labor is not progressing in a suitable manner.
Contraindications for use of Pitocin/Oxytocin include the following:
- An unengaged fetal head
- Significant cephalopelvic disproportion (CPD)
- Hypersensitivity to oxytocin or any component of the formulation
- Unfavorable fetal positions, such as a breech position
- Fetal distress when delivery is not about to happen
- Hypertonic and hyperactive uterus
- A contraindicated vaginal delivery, such as active genital herpes, prolapse of the cord, cord presentation, total placenta previa or vasa previa
- Obstetrical emergencies where surgical intervention is favored
- Where adequate uterine activity fails to achieve satisfactory progress
Pitocin/Oxytocin and Medical Malpractice
Dr. Tsimis’s study highlights the importance of following medical standards and indications when using oxytocin. Oxytocin can be very harmful to a baby. If a physician does not act in a manner consistent with medical guidelines, it is negligence. If this negligence results in injury to the baby or mother, it is medical malpractice.
The nationally recognized lawyers at Reiter & Walsh ABC Law Centers have many years of experience in birth injury cases that involve oxytocin. If your labor was induced using this drug and your child has been diagnosed with HIE, cerebral palsy or any other permanent injuries, we can help you. Our skilled attorneys will work tirelessly to obtain the compensation you and your family deserve. Call us at 888-419-2229 for a free consultation.