Maternal and Neonatal Outcomes after Implementation of a Pitocin Checklist Protocol

Objective: Standardized protocols are used throughout healthcare and have been applied to the administration of Pitocin during labor. Previous studies have shown various positive effects of a standardized Pitocin protocol. The purpose of this study was to examine if implementation of a standardized Pitocin checklist protocol on Prisma Health Labor and Delivery Units would improve maternal and neonatal outcomes, including cesarean

delivery rate, length of stay, NICU admissions, and APGAR scores at one and five minutes.

Study Design: This was a retrospective pre–post observational study to evaluate maternal and neonatal outcomes pre (April – June 2025) and post (September -November 2025) implementation of a Pitocin checklist protocol. Women who had a term delivery that received Pitocin were included. Exclusion criteria included delivery during the washout period (July-August 2025), preterm birth, stillbirth, and delivery at a Prisma Health facility outside of South Carolina. Data was abstracted from the electronic medical record.

Results: Cesarean delivery rate was higher in the post-implementation group (N=370) compared to the pre-implementation group (N=303; 27.8% vs. 20.5%; OR 1.50, 95% CI 1.05–2.15). However, after adjusting for gestational age at delivery, labor attempt, and delivery hospital, this was no longer statistically significant (adjusted OR 1.18, 95% CI 0.68–2.07). There were no significant differences in neonatal outcomes, as measured by APGAR scores at one minute (p = 0.39) and five minutes (p = 0.58), as well as NICU admissions (2.3% vs 0.8%; p=0.11). Maternal and infant hospital length of stay were also comparable between groups (p = 0.87 and p = 0.47, respectively).

Conclusion: While standardized Pitocin protocols can be used to improve labor management, their independent effect on cesarean rates may be limited. No negative effect on maternal or

neonatal outcomes was identified, verifying the safety of the protocol for continued use and ensuring future analysis of long-term outcomes.