oxytocin

• Oxytocin


  Hormone secreted by posterior pituitary gland, synthesized in the hypothalamus
• Action of Oxytocin (syntocinon)

  • Affects the pregnant uterus, increases the frequency, strength and duration of uterine contraction, Action lasts about half an hour

  
• Indications of oxytocin administration

  • Induction of abortion (inevitable, missed)
  • Induction and augmentation of labor
  • Prevention and treatment of post-partum hemorrhage and during cesarean section
  • Breast engorgement: oxytocin nasal drops or spray or buccal tablet at time of breast feeding to increase milk flow
• Indication of oxytocin administration

  • Post-abortive bleeding
  • During evacuation of hydatidiform mole to avoid perforation of uterus and excessive bleeding
  • Oxytocin stress test to assess fetal wellbeing
  • Uterine inertia during labor
  • Abruptio placenta
  • In the management of 3rd stage of labor

  
• Contraindication of oxytocin administration


  • Obstructed labor
  • Placental insufficiency
  • Malpresentation as transverse or oblique lie
  • Scar in the uterus (relative contraindication)
  • Grand multipara
  • Fetal distress
• Methods of administration


  • Orally
  • Intramuscularly (but avoided before delivery of the fetus)
  • Intrauterine (during cesarean section)
  • Intravenously (by the drip method, best method)
  • Nasal spray or drops
• Equipment


  • Electronic fetal monitor for continuous monitoring of FHR and uterine activity (CTG)
  • Ampoule of oxytocin (Pitocin 10 IU as ordered)
  • Infusion pump or IV set
  • 500 cc of ringer lactate or dextrose 5 %
  • Syringes 1cc, 2 cc needles & Tourniquet
  • Kidney basin
  • Cannula 20cm, cotton with alcohol and dry cotton
  • I.V. stand
  • Scissors and plaster
  • Label
  • Balance chart

  
• Procedure


  1. Hand washing

  2. Prepare the equipment

  3. Make sure that the woman who will receive the oxytocin is free from any risk factors (contraindications)

  4. Explain the procedure for using the oxytocin to the woman to alleviate anxiety, and gain her cooperation

  5. Ensure woman comfort (establish safe, quiet and clean environment)

  6. Bring equipment to the bedside

  7. Check the patient's vital signs, position of fetus, uterine contraction, cervical dilatation and fetal heart sounds before starting the infusion

  8. Wash hands and dry it well

  9. Ensure that the woman is on her left side

  10. Connect the woman with fetal monitor to assess fetal well-being and to establish a baseline for uterine activity

  11. Prepare the I.V. fluids

  12. Insert the cannula in the right hand and fix it with suitable size of plaster

  13. Start oxytocin infusion according to hospital protocol or physician's written orders

  14. Discontinue the oxytocin infusion and notify a physician if maternal or fetal complications have been developed

  
• Post-procedure: Record intake and output, Remove the equipment, Hand wash, Complete the Partogram date, let's the oxytocin infusion to be completed after delivery with close observation of any signs of postpartum hemorrhage until the dose that is finished