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Therapeutic indications
Antepartum
- Induction of labour for medical reasons, e.g. in cases of post-term gestation, premature rupture of membranes, pregnancy-induced hypertension (pre-eclampsia).
- Stimulation of labour in hypotonic uterine inertia.
- Early stages of pregnancy as adjunctive therapy for the management of incomplete, inevitable, or missed abortion.
Postpartum
- During caesarean section, following delivery of the child.
- Prevention and treatment of postpartum uterine atony and haemorrhage.
Dose and method of administration
Induction or enhancement of labour: Oxytocin should not be started for 6 hours following administration of vaginal prostaglandins.
Oxytocin should be administered as an intravenous (i.v.) drip infusion or, preferably, by means of a variable-speed infusion pump.
For drip infusion it is recommended that 5 IU (8.3 micrograms) of Oxytocin be added to 500 ml of a physiological electrolyte solution (such as sodium chloride 0.9 %). For patients in whom infusion of sodium chloride must be avoided, 5 % dextrose solution may be used as the diluent. To ensure even mixing, the bottle or bag must be turned upside down several times before use.
The initial infusion rate should be set at 2 to 8 drops/minute (1 to 4 milliunits/minute). It may be gradually increased at intervals not shorter than 20 minutes and increments of not more than 1 to 2 milliunits/minute, until a contraction pattern similar to that of normal labour is established. In pregnancy near term this can often be achieved with an infusion of less than 20 drops/minute (10 milliunits/minute), and the recommended maximum rate is 40 drops/minute (20 milliunits/minute). In the unusual event that higher rates are required, as may occur in the management of foetal death in utero or for induction of labour at an earlier stage of pregnancy, when the uterus is less sensitive to oxytocin, it is advisable to use a more concentrated oxytocin solution, e.g., 10 IU (16.7 micrograms) in 500 ml. When using a motor-driven infusion pump which delivers smaller volumes than those given by drip infusion, the concentration suitable for infusion within the recommended dosage range must be calculated according to the specifications of the pump.
The frequency, strength, and duration of contractions as well as the foetal heart rate must be carefully monitored throughout the infusion. Once an adequate level of uterine activity is attained, aiming for 3 to 4 contractions every 10 minutes, the infusion rate can often be reduced. In the event of uterine hyperactivity and/or foetal distress, the infusion must be discontinued immediately.
If, in women who are at term or near term, regular contractions are not established after the infusion of a total amount of 5 IU (8.3 micrograms), it is recommended that the attempt to induce labour be ceased; it may be repeated on the following day, starting again from a rate of 2 to 8 drops/minute (1 to 4 milliunits/minute)
Audited Supplier
Pharma Sources Insight June 2024: Globalization on the Go
