Augmentation of labour

1. The drug used for augmentation of labour is Syntocinon in Hartmann’s solution.

2. The indication for the use of Syntocinon is to augment established labour and occasionally to help induce labour following ARM...//

3. Indication for augmentation.

• During the first stage of labour when the cervix fails to dilate at the expected rate (<2 cm in 4 hours).
• During the second stage of labour to aid rotation of the head and its descent.

4. It is safe to augment primigravid labour but great care must be taken with parous patients.

5. Augmentation of parous patients may only be ordered by a registrar or consultant and the rate of infusion of Syntocinon determined for the individual patient.

6. Augmentation of a primigravid patient may be initiated by the midwife in charge of the case as in point 3 after discussion with the midwife in charge of labour ward.

7. The Syntocinon regime is 10 international units of Syntocinon made up as an infusion in 1 litre of Hartmann’s solution (see low dose regimen for severe pre-eclampsia).

The infusion should be run at the following rates/over:

Standard regimen:

8. The Syntocinon should be increased incrementally every 30 minutes until contractions lasting 40-50 seconds occur at intervals of 2-3 minutes. Patients requiring rates of Syntocinon infusion to achieve this greater than the above regime should be discussed with the obstetric registrar or the duty consultant.

9. The dosage of Syntocinon should be reduced after the patient has reached 5 cm dilation and in the rare case where the contractions subside, it can be incrementally increased again. When Syntocinon administration is initiated in the second stage (including the interval between first and second twin) it is reasonable to start at 30 ml/hr.

10. In severe pre-eclampsia, the volume of fluid infused may is reduced. Add 5 units of Syntocinon to 50 ml of Hartmann’s in a syringe driver and increase the incremental dose as described in point 8.

Severe pre-eclampsia regimen: