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  1. 1. Pharmacotherapy in Obstetric & Gynaecology: OXYTOCIN NAZNEEN VAHORA CLINICAL INSTRUCTOR MTIN,CHANGA
  2. 2. ACTIONACTION  It is released in large amounts after distension of cervix and vagina, nipple stimulation.  It contracts smooth muscle helping the expulsion of the foetus and ejection of breastmilk.  It also crosses the placenta and acts on the foetus neurons to prepare it for delivery- to sedate the brain.  Rapid acting: 1 minute if given IV; 3-7 minutes if given IM and lasts 30-60 minutes.
  3. 3. POTENTIAL ADVERSEPOTENTIAL ADVERSE REACTIONSREACTIONS  Seizures, subarachnoid haemorrhage  Tachycardia, hypotension, arrythymias  GU: uterine rupture, pelvic hamatoma, PPH, hypertonic uterine contractions  Foetal distress from Hypertonic U- increases c/s rate  Rapid or prolonged infusion causes water retention  Neonatal jaundice –crosses placenta.  Do not give rapid IV bolus for PPH ; hypotension
  4. 4.  Large doses- sustained contraction(↓ placental blood flow & fetal hypoxia/death)
  5. 5. SOURCESSOURCES  Corpus Luteum  PLACENTA ( may be foetus starts the labour)  Synthetic pitocin
  6. 6. USESUSES  Augmentation labour  Induction labour  PPH  Retained products conception  PIH patients – post partum
  7. 7. • Clinical use: - IOL (IVI 3U syntocinon+50 ml of saline) - Augment slow labour (IVI same as above)  3rd stage of labour- 5 U IM for HTN ,  cardiac disease- IVI 40 U in 500ml saline ( PPH)  Surgical termination of preg./ERPC (Evacuation of retained products of conception) - 5U slow IV
  8. 8. ASSESSMENT BEFOREASSESSMENT BEFORE augmentation/ inductionaugmentation/ induction  Previous c/s or other uterine surgery?  Twins?  CPD? History of CPD or borderline now.  Foetal distress?  Malpresentation including cord presentation  Praevia  Bishop score ( induction)
  9. 9. DOSAGESDOSAGES  Post partum -10u IMI on delivery of baby. Can be repeated.  PPH & RPOC (retained products of conception) – 20u in 1 liter MRL run @ 20ml /hr  Augmentation primipara- 5u in 1 liter RL titrated via IVAC to get regular contractions and reactive CTG (5ml/hr increasing 1 ml/hr)  Augmentation multipara – 2 u in 1 liter RL titrated via IV to give regular contractions & reactive CTG
  10. 10.  Pitocin should be piggybacked so that it can be stopped if necessary and IV line can then run.  Pitocin is used for PIH patients because syntometrine contains ergometrine (+pitocin) and it causes round muscle contraction – veins/arteries- so raises blood pressure.  Pitocin can also be injected into placental umbilical vein to get separation. (10u in 10ml)
  11. 11. STORAGESTORAGE  15-25o C – i.e. a fridge item.