The SOGC recently participated in a meeting with Health Canada and other partners to discuss the current shortage of oxytocin in Canada. Based on available information, it is estimated that there is a sufficient supply of oxytocin in Canadian obstetric units to last until replenishment, which, barring unforeseen circumstances, is expected by October 18, 2019.
Recommendations:
- Judicious use of oxytocin: Members are encouraged to continue to use oxytocin where indicated following the SOGC guidelines for induction and augmentation of labour, management of the third stage and prevention and management of postpartum hemorrhage. Practitioners are also encouraged to follow hospital policy with respect to the indications and protocols for oxytocin use.
- Avoidance of wastage of oxytocin: Consider opportunities to conserve supply and avoid waste, such as:
a) Avoid drawing up the dose of oxytocin prior to delivery in the event that an alternate route of administration may be required. This will lead to the wasting of the drawn up oxytocin.
b) Discuss with your hospital pharmacy if they can mix up IV bags using multi-dose vials. Recommended dilutions are 15 units in 250 mL or 30 units and 500 mL.
- Preparedness: Obstetrical units are advised to be prepared for an oxytocin shortage and to have considered protocols for alternative approaches. The SOGC Clinical Obstetrics and Maternal Fetal Medicine Committees are working to develop SOGC protocols for alternatives to oxytocin. In the interim, SOGC is providing protocols that are in use in Canada currently for the use of carbetocin in the third stage of labour at cesarean section, misoprostol for induction of labour and management of postpartum hemorrhage. Here are the protocols: Misoprostol Induction of Labour and Obstetric Induction and Cervical Ripening with Prostaglandin.
The oxytocin shortage has been designated Tier 3 by Health Canada, which means that they have gone from monitoring the situation to seeking alternate sources to ensure that there is medication available. This is not in reference to any new information, but from an abundance of caution and an understanding how important oxytocin is.
In the meantime, our advice remains to avoid unnecessary use of existing medications and to be prepared to use alternative medications.