Low and high dose oxytocin infusion protocols

Oxytocin should be administered by trained personnel who are familiar with its effects. It should be administered using an infusion pump that provides precise flow rate to ensure accurate minute-to-minute control. A maximum oxytocin dose has not been established, but most clinicians do not administer more than 40 milliunits/minute as the maximum dose.

For patients who have had a previous cesarean birth or other extensive transmyometrial surgery, some UpToDate contributors suggest using a low rather than high dose regimen, while others do not specifically avoid high dose regimens in these patients. The maximum safe dose in this setting is also unclear. Although many labor units use 20 milliunits/min in these patients, this is somewhat arbitrary, absolute risk differences between this maximum and higher maximums appear to be relatively small, and confounding by indication is possible. A prudent approach is to require the physician to be notified when 20 milliunits/min is reached.