MEDICATION GUIDE

Oxytocin (Pitocin)
ACTION Oxytocin is a hormone produced in the posterior pituitary gland that stimulates uterine contractions and aids in milk let-down. Pitocin is a synthetic form of this hormone. INDICATIONS Oxytocin is used primarily for labor induction and augmentation. DOSAGE AND ROUTE The intravenous solution containing oxytocin should be mixed in a standard concentration. Concentrations often used are 10 units in 1000 ml of uid, 20 units in 1000 ml of uid, or 30 units in 500 ml of uid. Oxytocin is administered intravenously through a secondary line connected to the main line at the proximal port (connection closest to the intravenous insertion site). Oxytocin is always administered by pump. Begin oxytocin administration at 1 milliunit/min. Increase the rate by 1 to 2 milliunits/min, no more frequently than every 30 to 60 minutes based on the response of the maternal-fetal unit and the progress of labor. The goal of oxytocin administration is to produce acceptable uterine contractions as evidenced by: Consistent achievement of 200 to 220 MVUs or A consistent pattern of one contraction every 2 to 3 minutes, lasting 80 to 90 seconds, and strong to palpation ADVERSE EFFECTS Possible maternal adverse effects include uterine tachysystole, placental abruption, uterine rupture, unnecessary cesarean birth caused by abnormal (nonreassuring) FHR and patterns, postpartum hemorrhage, and infection. Possible fetal adverse effects include hypoxemia and acidosis, eventually resulting in abnormal (nonreassuring) FHR and patterns. NURSING CONSIDERATIONS Client and partner teaching and support: Reasons for use of oxytocin (e.g., start or improve labor) Effects to expect concerning the nature of contractions: the intensity of the contraction increases more rapidly, holds the peak longer, and ends more quickly; contractions will come regularly and more often Monitoring to anticipate
FHR, Fetal heart rate; IV, intravenous; MVUs, Montevideo units.

Continue to keep woman and her partner informed regarding progress. Remember that women vary greatly in their response to oxytocin; some require only very small amounts of medication to produce adequate contractions, while others need larger doses. Assessment: Fetal status using electronic fetal monitoring; evaluate tracing every 15 minutes and with every change in dose during the rst stage of labor and every 5 minutes during the active pushing phase of the second stage of labor. Monitor the contraction pattern and uterine resting tone every 15 minutes and with every change in dose during the rst stage of labor and every 5 minutes during the second stage of labor. Monitor blood pressure, pulse, and respirations every 30 to 60 minutes and with every change in dose. Assess intake and output; limit IV intake to 1000 ml in 8 hours; urine output should be 120 ml or more every 4 hours. Perform vaginal examination as indicated. Monitor for side effects, including nausea, vomiting, headache, hypotension. Observe emotional responses of woman and her partner. Use a standard denition for uterine tachysystole that does not include an abnormal (nonreassuring) FHR and pattern or the womans perception of pain (see the Emergency Box: Uterine Tachysystole with Oxytocin). The rate of oxytocin infusion should be continually titrated to the lowest dose that achieves acceptable labor progress. Usually the oxytocin dose can be decreased or discontinued after rupture of membranes and in the active phase of rst stage labor. Documentation: The time the oxytocin infusion is begun, and each time the infusion is increased, decreased, or discontinued Assessment data as described above Interventions for uterine tachysystole and abnormal (nonreassuring) FHR and patterns and the response to the interventions Notication of the primary health care provider and that persons response

Sources: American College of Obstetricians and Gynecologists (ACOG). (2009). Induction of labor. ACOG Practice Bulletin No. 107. Washington, DC: ACOG; Clark, S., Simpson, K., Knox, G., & Garite, T. (2009). Oxytocin: New perspectives on an old drug. American Journal of Obstetrics and Gynecology, 200(1), 35,e1- e6; Mahlmeister, L. (2008). Best practices in perinatal care: Evidence-based management of oxytocin induction and augmentation of labor. Journal of Perinatal and Neonatal Nursing, 22(4), 259-263; Simpson, K. (2008). Labor and birth. In K. Simpson & P. Creehan (Eds.), AWHONNs perinatal nursing (3rd ed.). Philadephia: Lippincott Williams & Wilkins; Simpson, K., & Knox, G. (2009). Oxytocin as a high-alert medication: Implications for perinatal patient safety. MCN The American Journal of Maternal/Child Nursing, 34(1), 8-15.