Pitocin


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oxytocin

Pitocin, Syntocinon (CA) (UK), Syntometrine (UK)

Pharmacologic class: Posterior pituitary hormone

Therapeutic class: Uterine-active agent

Pregnancy risk category NR

FDA Box Warning

• Drug isn't indicated for elective induction of labor (defined as initiation of labor in pregnant woman with no medical indications for induction). Available data aren't adequate to evaluate benefits versus risk.

Action

Unknown. Thought to directly stimulate smooth muscle contractions in uterus and cervix.

Availability

Injection: 10 units/ml ampule or vial

Indications and dosages

To induce or stimulate labor

Adults: Initially, 1-ml ampule (10 units) in compatible I.V. solution infused at 1 to 2 milliunits/minute (0.001 to 0.002 units/minute). Increase rate in increments of 1 to 2 milliunits/minute q 15 to 30 minutes until acceptable contraction pattern is established.

To control postpartum bleeding

Adults: 10 to 40 units in compatible I.V. solution infused at rate adequate to control bleeding; or 10 units I.M. after placenta delivery

Incomplete abortion

Adults: 10 units in compatible I.V. solution infused at 10 to 20 milliunits/minute (0.01 to 0.02 units/minute)

Off-label uses

• Antepartal fetal heart rate testing
• Breast enlargement

Contraindications

• Hypersensitivity to drug
• Cephalopelvic disproportion
• Fetal distress when delivery is not imminent
• Prolonged use in uterine inertia or severe toxemia
• Hypertonic or hyperactive uterine pattern
• Unfavorable fetal position or presentation that's undeliverable without conversion
• Labor induction or augmentation when vaginal delivery is contraindi-cated (as in invasive cervical cancer, active genital herpes, or total placenta previa)

Precautions

Use cautiously in:
• previous cervical or uterine surgery, history of uterine sepsis
• breastfeeding patients.

Administration

• Reconstitute by adding 1 ml (10 units) to 1,000 ml of normal saline solution, lactated Ringer's solution, or dextrose 5% in water.

Don't give by I.V. bolus injection.
• Infuse I.V. using controlled-infusion device.
• Be aware that drug isn't routinely given I.M.
• Know that drug should be given only to inpatients at critical care facilities when prescriber is immediately available.

Adverse reactions

CNS: seizures, coma, neonatal brain damage, subarachnoid hemorrhage

CV: premature ventricular contractions, arrhythmias, neonatal bradycardia

GI: nausea, vomiting

GU: postpartal hemorrhage; pelvic hematoma; uterine hypertonicity, spasm, or tetanic contraction; abruptio placentae; uterine rupture (with excessive doses)

Hematologic: afibrinogenemia

Hepatic: neonatal jaundice

Other: hypersensitivity reactions including anaphylaxis, low 5-minute Apgar score (neonate)

Interactions

Drug-drug.Sympathomimetics: postpartal hypertension

Thiopental anesthetics: delayed anesthesia induction

Vasoconstrictors: severe hypertension (when given within 3 to 4 hours of oxytocin)

Drug-herbs.Ephedra (ma huang): increased hypertension

Patient monitoring

Continuously monitor contractions, fetal and maternal heart rate, and maternal blood pressure and ECG. Discontinue infusion if uterine hyper-activity occurs.

Monitor patient extremely closely during first and second stages of labor because of risk of cervical laceration, uterine rupture, and maternal and fetal death.
• When giving drug to control postpartal bleeding, monitor and record vaginal bleeding.
• Assess fluid intake and output. Watch for signs and symptoms of water intoxication.

Patient teaching

• Inform patient about risks and benefits of oxytocin-induced labor.

Teach patient to recognize and immediately report adverse drug effects.

Pitocin

(pĭ-tō′sĭn)
A trademark for a drug preparation of oxytocin.

Pitocin

a trademark for an oxytocic (oxytocin).

Pitocin

Obstetrics A proprietary oxytocin, see there.
References in periodicals archive ?
Julian Ullman said that prior to increasing the Pitocin, the standard of care required a vaginal exam, and that would have shown that Kim needed an immediate cesarean section.
I was careful to find a nice OB that would support my feelings on VBAC and I did not desire pitocin at all
The defense summation was essentially based on the science offered by the defense experts--that the child's injuries were not the result of any actions taken by the defendants and that the nurse's actions in giving Pitocin were appropriate.
The plaintiffs' experts concluded that the oxygen deprivation had occurred within the last one and one-half hours before birth, which was the exact time during which Pitocin was administered.
Prodromal labor is a not uncommon test of wills, a lesson in how little control we have over nature, and an opportunity to prove to those who set limits that far more valuable than pitocin is time, respect, and honor.
In the component of your policy about decreasing or stopping Pitocin, consider this wording: "Decrease/discontinue Pitocin for excessive uterine contractions or when fetal heart rate pattern warrants discontinuation.
The other problem he sees is that nurses and other members of the labor and delivery team are unaware that a Pitocin policy exists in their institution.
In the three most recent obstetrical malpractice cases in which he served as a defense attorney, the physicians gave nurses orders for Pitocin (oxytocin) that contradicted the hospital protocol for Pitocin use, he said at a conference or, obstetrics, gynecology, perinatal medicine, neonatology, and the law.
I went to Debbie and told her that possibly the pitocin should be decreased.
Be careful with Pitocin and be careful with instrumental deliveries," Dr.
I watched as the IV was inserted and the pitocin drip was begun.
The likelihood of C-section in 8,715 low-risk nulliparous patients with term singletons delivered at a community hospital over an 8-year period increased with maternal age regardless of spontaneous labor, Pitocin augmentation, or induction, she said in a poster presentation at the annual meeting of the Society for Maternal-Fetal Medicine.