title: Unintended clinical consequences of the implementation of a checklist-based, low-dose oxytocin protocol.
abstract: OBJECTIVE
  Standardized oxytocin protocols have been used to improve the safety and quality of obstetric care. We examined rates of chorioamnionitis and labor dystocia requiring cesarean delivery as unintended consequences of the implementation of a low-dose, checklist-based oxytocin protocol.
  
  
  METHODS
  We performed a retrospective cohort study of live singleton deliveries that underwent a trial of labor in two 15-month periods, comparing outcomes in those who delivered before to after protocol implementation. Patients and outcomes were identified using a combination of electronic medical records and International Classification of Diseases, 9th Revision, Clinical Modification codes. Time trend analysis was performed to evaluate for secular trends.
  
  
  RESULTS
  A total of 8,717 women were included; 5,077 received oxytocin. Despite an unchanged rate of cesarean deliveries from before to after initiation of the protocol (15.15 vs. 14.75%, p = 0.60), deliveries after protocol implementation were generally characterized by higher rates of chorioamnionitis (7.48 vs. 5.97%, p < 0.001), longer median time from admission to delivery (524 vs. 462 minutes, p < 0.001), more cesarean deliveries performed for labor dystocia (50.62 vs. 40.92%, p < 0.001), and fewer cesarean deliveries performed for fetal distress (32.52 vs. 38.67%, p = 0.02).
  
  
  CONCLUSIONS
  Low-dose oxytocin protocols are intended to increase safety, but they may have unintended consequences related to prolonged labor, and should be studied before widespread use.
authors.affiliation: Maternal and Child Health Research Program, Department of Obstetrics and Gynecology, Center for Research on Reproduction and Women's Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Amanda E
authors.initials: AE
authors.lastname: Rohn
authors.affiliation: Maternal and Child Health Research Program, Department of Obstetrics and Gynecology, Center for Research on Reproduction and Women's Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Jamie A
authors.initials: JA
authors.lastname: Bastek
authors.affiliation: Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics (CCEB), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Mary D
authors.initials: MD
authors.lastname: Sammel
authors.affiliation: Maternal and Child Health Research Program, Department of Obstetrics and Gynecology, Center for Research on Reproduction and Women's Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Eileen
authors.initials: E
authors.lastname: Wang
authors.affiliation: Maternal and Child Health Research Program, Department of Obstetrics and Gynecology, Center for Research on Reproduction and Women's Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Sindhu K
authors.initials: SK
authors.lastname: Srinivas
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data; D057189:Checklist; D002821:Chorioamnionitis / Q000453:epidemiology; D002985:Clinical Protocols; D004420:Dystocia / Q000188:drug therapy / Q000453:epidemiology*; D057286:Electronic Health Records; D005260:Female; D005316:Fetal Distress; D005323:Fetal Monitoring; D006801:Humans; D038801:International Classification of Diseases; D007751:Labor, Induced; D007744:Obstetric Labor Complications / Q000188:drug therapy / Q000453:epidemiology*; D010120:Oxytocics / Q000627:therapeutic use*; D010121:Oxytocin / Q000009:adverse effects / Q000627:therapeutic use*; D011247:Pregnancy; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D010120:Oxytocics; D010121:Oxytocin