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Pharmacotherapy in Obstetric
& Gynaecology: OXYTOCIN
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.
POTENTIAL ADVERSEPOTENTIAL ADVERSE
Seizures, subarachnoid haemorrhage
Tachycardia, hypotension, arrythymias
GU: uterine rupture, pelvic hamatoma, PPH, hypertonic
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
Large doses- sustained contraction(↓ placental
blood flow & fetal hypoxia/death)
PLACENTA ( may be foetus starts the
Retained products conception
PIH patients – post partum
• Clinical use:
- IOL (IVI 3U syntocinon+50 ml of saline)
- Augment slow labour (IVI same as above)
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
ASSESSMENT BEFOREASSESSMENT BEFORE
augmentation/ inductionaugmentation/ induction
Previous c/s or other uterine surgery?
CPD? History of CPD or borderline now.
Malpresentation including cord presentation
Bishop score ( induction)
Post partum -10u IMI on delivery of baby.
Can be repeated.
PPH & RPOC (retained products of
conception) – 20u in 1 liter MRL run @ 20ml
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 &
Pitocin should be piggybacked so that it can
be stopped if necessary and IV line can then
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)
C – i.e. a fridge item.
PIGGYBACK IVPIGGYBACK IV