The use of oxytocin.

Synthetic oxytocin offers a safe and effective means of producing regular uterine activity and has a fairly large therapeutic index; however, the mild antidiuretic and vasoactive properties of oxytocin increase the risk of water intoxication and hypotension. The issue of reduction in cesarean section rates through the use of an active management protocol is being studied actively in the United States and Canada at this time. The authors recommend infusion protocols for the augmentation and induction of labor that use low doses of dilute oxytocin, increased at intervals no more than 40 minutes. Pharmacokinetic and clinical studies support the use of oxytocin in the physiologic range as efficacious and prudent. The longer induction to delivery time demonstrated by some, but not all authors, in our opinion, is a reasonable alternative to avoidable uterine hyperstimulation with the potential for fetal and maternal injury. We advocate the use of the lowest dose necessary to produce adequate uterine contractility and cervical change.