Effect of Oxytocin-Conserving Policy on Labor and Postpartum Management and Patient and Neonatal Outcomes [ID 1011]

INTRODUCTION: On October 6, 2022, Pomona Valley Hospital Medical Center (PVHMC) was notified of a nationwide synthetic oxytocin shortage. A policy was implemented to enforce a judicious use of this medication in labor and postpartum. This study aimed to assess the effect on clinical management and on patient and neonatal outcomes. METHODS: Data were collected via retrospective chart review from nursing and physician documentation on the labor and postpartum course. Inclusion criteria were patients who delivered at PVHMC from September 6 to November 7, 2022. Exclusion criteria were cesarean birth admissions. Patients were divided into groups based on whether they delivered before or after implementation of the policy. Data were compared using t-tests for continuous variables or the chi-squared analysis for categorical variables. RESULTS: Seven hundred nine patients met the criteria, with 342 delivering prior to and 367 delivering after implementation of the policy. The percentage of patients receiving misoprostol increased (32.8% versus 42.9%, P =.005). The percentage receiving synthetic oxytocin decreased (64.3% versus 31.1%, P <.001). Postpartum, the percentage of patients receiving synthetic oxytocin decreased (92.1% versus 52.6%, P <.001) whereas the percentage receiving misoprostol, methylergonovine, and tranexamic acid increased (21.9% versus 42.0%, P <.001; 17.5% versus 43.2%, P <.001; 14.0% versus 26.2%, P <.001). There was no significant difference in cesarean birth rates, quantitative blood loss, blood transfusion, or neonatal outcomes. CONCLUSIONS/IMPLICATIONS: In our population, labor and the postpartum period were managed safely and effectively with selective use of synthetic oxytocin. Understanding various management strategies allows institutions to adapt as availability of resources fluctuates.