How much synthetic oxytocin is infused during labour? A review and analysis of regimens used in 12 countries

Objective

To compare synthetic oxytocin infusion regimens used during labour, calculate the International Units (IU) escalation rate and total amount of IU infused over eight hours.

Design

Observational study

Setting

Twelve countries, eleven European and South Africa.

Sample

National, regional or institutional-level regimens on oxytocin for induction and augmentation labour

Methods

Data on oxytocin IU dose, infusion fluid amount, start dose, escalation rate and maximum dose were collected. Values for each regimen were converted to IU in 1000ml diluent. One IU corresponded to 1.67μg for doses provided in grams/micrograms. IU hourly dose increase rates were based on escalation frequency. Cumulative doses and total IU amount infused were calculated by adding the dose administered for each previous hour. Main Outcome Measures Oxytocin IU dose infused

Results

Data were obtained on 21 regimens used in 12 countries. Details on the start dose, escalation interval, escalation rate and maximum dose infused were available from 16 regimens. Starting rates varied from 0.06 IU/hour to 0.90 IU/hour, and the maximum dose rate varied from 0.90 IU/hour to 3.60 IU/hour. The total amount of IU oxytocin infused, estimated over eight hours, ranged from 2.38 IU to 27.00 IU, a variation of 24.62 IU and an 11-fold difference.

Conclusion

Current variations in oxytocin regimens for induction and augmentation of labour are inexplicable. It is crucial that the appropriate minimum infusion regimen is administered because synthetic oxytocin is a potentially harmful medication with serious consequences for women and babies when inappropriately used. Estimating the total amount of oxytocin IU received by labouring women, alongside the institution’s mode of birth and neonatal outcomes, may deepen our understanding and be the way forward to identifying the optimal infusion regimen.

Focus group discussions of registered nurses' perceptions of challenges in the medication administration process

Medication administration (MA) holds a great threat to patient safety, as MA errors remain a global problem. Nurses are key role players in the MA process and can give valuable information from the grassroots level. The aim of the present study was to describe registered nurses' perceptions related to challenges in the MA process. Focus group interviews with registered nurses (n = 20) in two central hospitals in Finland were conducted in 2015. Inductive content analysis was performed. Nurses described multiple challenges during MA, which made the process demanding. These were organized under five themes: (i) medications; (ii) collaboration between health-care professionals; (iii) resources and work environment; (iv) skills and education; and (v) patient-related factors. The MA process is prone to errors, and registered nurses described many challenges related to MA. While nurses are responsible for their various work-related tasks and the maintenance of patient safety through applicable procedures and effective collaboration, health systems and hospital management should be stewards of patient safety by ensuring adequate staffing levels and providing educational resources related to the MA process.

Antibody responses to La Sota strain vaccines of Newcastle disease virus in ostriches (Struthio camelus) as detected by enzyme-link ed immunosorbent assay

Because of the fact that South Africa is a Newcastle disease virus (NDV)-endemic country, major concerns exist that the export of ostrich meat could transmit velogenic strains of this disease. The ability to transmit the virus could be reduced by effective vaccination of South African ostriches. In this study, two vaccination trials were conducted to assess serum antibody production in response to vaccination with La Sota strain NDV vaccines. To this end, a commercially available chicken anti-NDV enzyme-linked immunosorbent assay (ELISA) was modified for the detection of anti-NDV antibodies in ostrich serum. The results obtained with this ELISA were verified by comparison with an indirect ELISA. In the first trial, ostriches were immunized subcutaneously four times with different volumes of an inactivated vaccine and their immune response was determined from 2.5 mo up to the ideal slaughter age of 14 mo. Results indicated that ostriches responded in a dose-dependent manner and gave support for the vaccination schedule currently recommended to South African farmers. In a second trial, immunization by eyedrop with a live La Sota vaccine of 5-wk-old ostriches did not elicit a humoral immune response. The results indicate that it is highly unlikely that ostriches that have been vaccinated according to the recommended vaccination schedule can transmit the virus.