A 28-year-old client at 41 weeks gestation is receiving oxytocin IV for labor augmentation. The nurse notes 7 contractions in 10 minutes, contractions lasting more than 90 seconds, and late decelerations on the fetal monitor. Which is the priority nursing action?

Oxytocin (Pitocin) is a high-alert medication used IV for labor induction and augmentation, postpartum hemorrhage, and milk letdown. The major risks are uterine tachysystole (more than 5 contractions per 10 minutes averaged over 30 minutes), hypertonus (contractions lasting more than 90 seconds or coupling), and water intoxication at high doses (oxytocin has antidiuretic activity). Tachysystole compromises placental perfusion and causes fetal hypoxia, manifesting as late decelerations or bradycardia. Standard intrauterine resuscitation: (1) stop or decrease the oxytocin infusion immediately, (2) reposition to left lateral to relieve aortocaval compression, (3) administer oxygen 8 to 10 L/min via non-rebreather mask, (4) increase the IV maintenance fluid bolus to improve placental perfusion, (5) notify the obstetric provider, (6) administer terbutaline 0.25 mg SC as a uterine relaxant if hyperstimulation persists, (7) prepare for possible operative delivery if tracing does not improve. Increasing oxytocin or continuing without intervention worsens fetal compromise. Magnesium sulfate is used for tocolysis in preterm labor, not for oxytocin-induced tachysystole; it would not replace stopping the agent.

Stop the oxytocin first — that is always the first action when tachysystole or category III tracing appears. The mnemonic is: stop, side, oxygen, fluid, notify (SSOFN).