Oxytocin Uses && Dangers: Mohamad Atef Radwan

Oxytocin; Uses && Dangers
Mohamad Atef Radwan
Rotunda Hospital
June 3, 2020
Mohamad Atef Radwan (Rotunda Hospital) Oxytocin; Uses && Dangers June 3, 2020 1 / 32
Î.Todo
Physiology & Pharmacology

Uses
1 PPH Prevention
2 PPH Treatment
Doses
Side Effects
Evidence
Secreted from Post. Pituitary

9 Amino Acid Peptide Hormone
InEffective Orally
Vasopressin Like ?
9 Amino Acid Peptide Hormone

Secreted from Post. Pituitary
Ineffective Orally
Vasopressin Like ?
Pharmacodynamics
Acts Through G-Protein coupled Receptors

IP3 ○ Ca++ ○ Uterine contraction
Increase PG/ Leukotrienes ○ Uterine Contraction
The concentration of myometrial oxytocin receptors increases with
advancing gestation
Oxytocin Receptor Desensitization
Oxytocin receptor downregulation has been confirmed in an in-vivo

study in human myometrial tissue from women exposed to oxytocin
during labour
Oxytocin receptor concentrations decreased more than three-fold, and
oxytocin receptor mRNA concentrations decreased 60-fold and
300-fold during oxytocin-augmented and oxytocin-induced labour
respectively.
Uses
Augmentation of the labour

Prevention and treatment of postpartum hemorrhage
Breast Engorgement
Uses
/////////////////
Augmentation/// of/////
the////////
labour
Prevention and treatment of postpartum hemorrhage
////////
Breast////////////////
Engorgement
Uses
^ Postpartum haemorrhage (PPH)

remains the most common cause of
maternal mortality worldwide (30 %)
Most PPHs result from an atonic uterus
uterus
Qs ?
PPH-Prevention
Active management of the third stage of labour

Oxytocin is by far the most common prophylactic in use, and is
usually given after delivery of the baby or the placenta.
Drug recommended by the WHO the UK National Institute for Health
and Care Excellence (NICE), and the International Federation of
Gynecology and Obstetrics (FIGO)
Consistently reduce excessive blood loss by 50–70%.
Prevention.Evidence.Review
Dose.ED90
○ The dosage of uterotonic agents, primarily oxytocin, at cesarean

delivery is highly variable and may frequently exceed that necessary to
obtain adequate uterine tone
○ The ED90 of oxytocin to be 0.35 units in patients undergoing elective
CD.
Dose.Note
○ Women with prior exposure to exogenous Oxytocin require a higher

initial infusion (Oxytocin receptor desensitization) rate of Oxytocin to
prevent uterine atony after cesarean delivery than women without prior
exposure. è
Dose.dose
ED 90 in Emergency CD
The ED90 for Oxytocin during non elective CD was reported as 2.99 IU,
which suggests that a higher dose of Oxytocin is needed to achieve
adequate uterine tone for non elective Cesarean delivery. (One Study)
Prevention.Evidence.Guideline
For women without risk factors for PPH delivering vaginally, oxytocin
(10 IU by intramuscular injection) is the agent of choice for
prophylaxis in the third stage of labour.
A higher dose of oxytocin is unlikely to be beneficial.
For women delivering by caesarean section, oxytocin (5 IU by slow
intravenous injection) should be used to encourage contraction of the
uterus and to decrease blood loss.
PPH-Prevention Cont.
PPH.Prevention
3rd Stage
Preventive administration of uterotonics is effective in reducing the
incidence of PPH, and oxytocin is the preferred treatment (Grade A).
It can be administered after delivery of the shoulders or rapidly after
birth, or after placental delivery if not performed previously (Grade B).
A dose of 5 or 10 IU can be administered (Grade A) either IV or IM
(professional consensus).
PPH. Prevention.Cont
3rd Stage
For IV administration, a slow IV injection (lasting approximately
one minute) is preferable
Very slow IV administration—for longer than five minutes—is
recommended to limit hemodynamic effects In women at
cardiovascular risk (professional consensus).
Routine maintenance infusion of Oxytocin is not recommended
(professional consensus).
In cases of placental retention, Oxytocin administration is not effective
LSCS And Oxytocin
LSCS...
A slow (at least one-minute) IV injection of 5–10 IU of oxytocin is
recommended (Grade A) except for women with overt cardiovascular
risks, when the injection must last at least 5 min to limit its
hemodynamic effects (professional consensus).
Routine maintenance treatment by an IV oxytocin infusion can be
performed as long as it does not exceed 10 IU/h (professional
consensus).
The treatment can be stopped at the end of two hours if uterine tone
is satisfactory and there is no abnormal bleeding.
PPH.Treatment
Treatment consists of a slow IV or IM injection of 5–10 IU oxytocin

followed by a maintenance infusion of 5–10 IU/h for 2 h (professional
consensus). The cumulative dose must not exceed 40 IU, – Frensh
Oxytocin 5 iu by slow intravenous injection (Dose May be repeated)
Oxytocin infusion (40 IU in 500 ml isotonic crytalloid at 125 ml/hour)
– Guideline 52
Dose, Updated
Oxytocin has significant adverse effects when givenas a rapid

high-dose bolus.
It should therefore be given slowly to reduce these effects.
A small initial dose followed by a controlled infusion is the optimum
approach
Dose, updated
Rotunda’s Oxytocin Infusion
Reduced risk of serious adverse outcomes due to oxytocin free flow

errors/mix ups between Oxytocin and other infusions
Immediate treatment of a PPH if it occurs after
induction/acceleration of labour (rate change only)
Effects.z
∠ SAP , MAP
∠ HR (2.5 min) baseline after (5 min)
Effects.z
Effects.z
Ë
“The lack of a SV increase in the
placebo group challenges the
hypothesis that uterine contraction
causes autotransfusion of uterine
blood that leads to an increase in
preload”
z . Side.Effect
Cardiovascular effects of oxytocin may be poorly tolerated if

ventricular function is abnormal.
10 IU Oxytocin
A 10 IU bolus of Oxytocin was the precipitating cause of death in two
women, one of whom had a high spinal block and was also hypovolaemic,
and the other who had pulmonary hypertension
Women with significant cardiac disease may be very sensitive to the

adverse effects of Oxytocin and other uterotonics, and their
management needs to be individualised
ST segment ??
z.Side.Effect
In Pre-eclamptic, Decrease of Cardiac ♥ output was observed

patients receiving 5 IU (Small Sample)
There is no consensus on best practice for oxytocin use for this
high-risk population undergoing caesarean delivery
○ Ultra-low doses of oxytocin (dose range 0.05–0.5 IU), repeated as

necessary
Side.Effects
Nausea, vomiting, headache and flushing

large doses of oxytocin may cause water retention, hyponatremia,
seizures and coma
vLike A SIADH
I Higher doses (eg, 50 milliunits/minute) of oxytocin are administered in large
quantities (eg, over 3 liters) of hypotonic solutions (eg, 5 percent dextrose in
water [D5W]) for prolonged periods of time (≥7 hours )
I Excessive water retention can occur and result in severe, symptomatic
hyponatremia, similar to the SIADH
International consensus statement
The End
Questions?

Oxytocin Uses && Dangers: Mohamad Atef Radwan

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Oxytocin; Uses && Dangers

Mohamad Atef Radwan

Physiology & Pharmacology

Secreted from Post. Pituitary

9 Amino Acid Peptide Hormone

Acts Through G-Protein coupled Receptors

Oxytocin receptor downregulation has been confirmed in an in-vivo

Augmentation of the labour

^ Postpartum haemorrhage (PPH)

Active management of the third stage of labour

○ The dosage of uterotonic agents, primarily oxytocin, at cesarean

○ Women with prior exposure to exogenous Oxytocin require a higher

Treatment consists of a slow IV or IM injection of 5–10 IU oxytocin

Oxytocin has significant adverse effects when givenas a rapid

Reduced risk of serious adverse outcomes due to oxytocin free flow

Cardiovascular effects of oxytocin may be poorly tolerated if

Women with significant cardiac disease may be very sensitive to the

In Pre-eclamptic, Decrease of Cardiac ♥ output was observed

○ Ultra-low doses of oxytocin (dose range 0.05–0.5 IU), repeated as

Nausea, vomiting, headache and flushing

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