Unyime Ituk
The reported risk of nonreassuring fetal heart trace following neuraxial analgesia is 3-23%. This variability may be due to fluid and oxytocin management prior to and during the initiation of neuraxial analgesia. The study hypothesis is that decreasing the oxytocin infusion rate by 50 % prior to initiation of combined spinal epidural analgesia will cause a reduction in the incidence of adverse fetal heart rate changes.
Oxytocin is used in labor and delivery to increase the frequency of contractions and augment uterine contractile strength, thereby establishing a regular pattern of labor. However, the administration of exogenous oxytocin in the presence of an uncoordinated labor pattern confers a risk for an increase in uterine contraction frequency, resulting in inadequate relaxation periods. This leads to an increase in the basal tone of the uterus, which may lead to a tetanic contraction with the risk of decreased uteroplacental blood flow and fetal hypoxemia. Previous studies investigating low- versus hig…
Inclusion Criteria: * Healthy nulliparous or multiparous women at term (37 \> weeks' gestation) * Singleton pregnancy * Request for neuraxial analgesia * Oxytocin used for induction of labor or augmentation of labor per institutional protocols Exclusion Criteria: * Use of chronic analgesic medications * Prior administration of systemic opioid labor analgesia * Non-vertex presentation * Contraindication to neuraxial analgesia * Category 3 fetal heart rate tracing prior to the initiation of combined spinal epidural analgesia
Patients randomized to the half dose oxytocin group will have the oxytocin infusion reduced to 50 % prior to placement of combined spinal epidural for labor analgesia
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