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Objective To assess the use of an evidence-based oxytocin protocol for management of the third stage of labor to decrease non-beneficial clinical variation and improve clinical outcomes. Design This is a cohort study of pregnant patients delivering before implementation of an evidence-based oxytocin protocol compared to patients delivering after implementation of an evidence-based oxytocin protocol. Setting A level III maternal care referral hospital with an average delivery volume of approximately 3,000 deliveries Participants Pregnant patients delivering over a 60-month period from Jan 2013 to December 2017. Intervention An evidence-based oxytocin protocol: 3-units of oxytocin administered over 3 minutes, with a second 3-unit bolus if inadequate tone, then oxytocin infusion at 18 units/hr x 1 hour, then 3.6 units/hr for 3 hours. Main Outcome Measures Postpartum hemorrhage (PPH) rate (EBL ≥ 500 mL for vaginal, ≥ 1,000 mL for cesarean) Results Data from 14,603 deliveries was analyzed; 8,408 pre-protocol; 6,195 post-protocol. We demonstrated a significant decrease in PPH from 5.2% to 2.9% (p<0.001) and small but non-significant increase in transfusion rate from 1.8% to 2.3% (p=0.11). Conclusion A standardized oxytocin infusion protocol in the third stage of labor resulted in a significant decrease in PPH for both vaginal and cesarean deliveries.

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