Nursing considerations when administering Pitocin for labor augmentation
What is Pitocin and how is it used?Pitocin is a prescription medicine used to treat the symptoms of postpartum hemorrhage, labor induction, and incomplete or inevitable abortion. Pitocin may be used alone or with other medications. Show
Pitocin belongs to a class of drugs called Oxytocic Agents. It is not known if Pitocin is safe and effective in children. What are the possible side effects of Pitocin?Pitocin may cause serious side effects including:
Serious side effects for the baby:
Get medical help right away, if you have any of the symptoms listed above. The most common side effects of Pitocin include:
Tell the doctor if you have any side effect that bothers you or that does not go away. These are not all the possible side effects of Pitocin. For more information, ask your doctor or pharmacist. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. Pharmacy Bulk Package - Not for Direct Infusion DESCRIPTIONPitocin (oxytocin injection, USP) is a sterile, clear, colorless aqueous solution of synthetic oxytocin, for intravenous infusion or intramuscular injection. Pitocin is a nonapeptide found in pituitary extracts from mammals. It is standardized to contain 10 units of oxytocic hormone/mL and contains 0.5% Chlorobutanol, a chloroform derivative as a preservative, with the pH adjusted with acetic acid. Pitocin may contain up to 16% of total impurities. The hormone is prepared synthetically to avoid possible contamination with vasopressin (ADH) and other small polypeptides with biologic activity. Pitocin has the empirical formula C43H66N12O12S2 (molecular weight 1007.19). The structural formula is as follows: 3 pharmacies near 55807 have coupons for pitocin (Brand Names:Pitocin for 1ML of 10UNIT/ML)INDICATIONSIMPORTANT NOTICE Elective induction of labor is defined as the initiation of labor in a pregnant individual who has no medical indications for induction. Since the available data are inadequate to evaluate the benefitsto- risks considerations, Pitocin is not indicated for elective induction of labor. AntepartumPitocin is indicated for the initiation or improvement of uterine contractions, where this is desirable and considered suitable for reasons of fetal or maternal concern, in order to achieve vaginal delivery. It is indicated for (1) induction of labor in patients with a medical indication for the initiation of labor, such as Rh problems, maternal diabetes, preeclampsia at or near term, when delivery is in the best interests of mother and fetus or when membranes are prematurely ruptured and delivery is indicated; (2) stimulation or reinforcement of labor, as in selected cases of uterine inertia; (3) as adjunctive therapy in the management of incomplete or inevitable abortion. In the first trimester, curettage is generally considered primary therapy. In second trimester abortion, oxytocin infusion will often be successful in emptying the uterus. Other means of therapy, however, may be required in such cases. PostpartumPitocin is indicated to produce uterine contractions during the third stage of labor and to control postpartum bleeding or hemorrhage. QUESTIONThe first sign of pregnancy is most often: See AnswerDOSAGE AND ADMINISTRATIONParenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit. The dosage of oxytocin is determined by the uterine response and must therefore be individualized and initiated at a very low level. The following dosage information is based upon various regimens and indications in general use. Induction Or Stimulation Of LaborIntravenous infusion (drip method) is the only acceptable method of parenteral administration of Pitocin for the induction or stimulation of labor. Accurate control of the rate of infusion is essential and is best accomplished by an infusion pump. It is convenient to piggyback the Pitocin infusion on a physiologic electrolyte solution, permitting the Pitocin infusion to be stopped abruptly without interrupting the electrolyte infusion. This is done in the following way. Preparation
AdministrationThe initial dose should be 0.5–1 mU/min (equal to 3–6 mL of the dilute oxytocin solution per hour). At 30–60 minute intervals the dose should be gradually increased in increments of 1–2 mU/min until the desired contraction pattern has been established. Once the desired frequency of contractions has been reached and labor has progressed to 5–6 cm dilation, the dose may be reduced by similar increments. Studies of the concentrations of oxytocin in the maternal plasma during Pitocin infusion have shown that infusion rates up to 6 mU/min give the same oxytocin levels that are found in spontaneous labor. At term, higher infusion rates should be given with great care, and rates exceeding 9–10 mU/min are rarely required. Before term, when the sensitivity of the uterus is lower because of a lower concentration of oxytocin receptors, a higher infusion rate may be required. Monitoring
Control Of Postpartum Uterine Bleeding
Treatment Of Incomplete, Inevitable, Or Elective AbortionIntravenous infusion of 10 units of Pitocin added to 500 mL of a physiologic saline solution or 5% dextrose-in-water solution may help the uterus contract after a suction or sharp curettage for an incomplete, inevitable, or elective abortion. Subsequent to intra-amniotic injection of hypertonic saline, prostaglandins, urea, etc., for midtrimester elective abortion, the injection-to-abortion time may be shortened by infusion of Pitocin at the rate of 10 to 20 milliunits (20 to 40 drops) per minute. The total dose should not exceed 30 units in a 12-hour period due to the risk of water intoxication. Directions For DispensingPharmacy Bulk Package – Not for Direct Infusion: The pharmacy bulk package is for use in a pharmacy admixture service only in a suitable work area, such as a laminar flow hood. The closure should be penetrated only once utilizing an appropriate sterile transfer device, which allows measured distribution of the contents. The transfer device should be inserted into the Pharmacy Bulk Package using aseptic technique. Contents should be used as soon as possible following initial closure puncture. Discard any unused portion within 24 hours of first entry. Following closure puncture, container should be maintained under labeled storage conditions between 20° to 25°C (68° to 77°F) under a laminar flow hood until contents are dispensed. HOW SUPPLIEDPitocin (Oxytocin Injection, USP) Synthetic is available as follows: NDC 42023-130-06 Packages of six 50 mL Pharmacy Bulk Packages, each containing 10 units of oxytocin per mL (total = 500 units of oxytocin per vial). StorageStore between 20° to 25°C (68° to 77°F). See USP Controlled Room Temperature. REFERENCES 1. Seitchik J, Castillo M: Oxytocin augmentation of dysfunctional labor. I. Clinical data. Am J Obstet Gynecol 1982; 144:899–905. 2. Seitchik J, Castillo M: Oxytocin augmentation of dysfunctional labor. II. Multiparous patients. Am J Obstet Gynecol 1983; 145:777–780. 3. Fuchs A, Goeschen K, Husslein P, et al: Oxytocin and the initiation of human parturition. III. Plasma concentrations of oxytocin and 13, 14-dihydro-15-keto-prostaglandin F2a in spontaneous and oxytocin-induced labor at term. Am J Obstet Gynecol 1983; 145:497–502. 4. Seitchik J, Amico J, et al: Oxytocin augmentation of dysfunctional labor. IV. Oxytocin pharmacokinetics. Am J Obstet Gynecol 1984; 150:225–228. 5. American College of Obstetricians and Gynecologists: ACOG Technical Bulletin Number 110— November 1987: Induction and augmentation of labor. Distributed by: Par Pharmaceutical, Chestnut Ridge, NY 10977. Revised : Nov 2020 Side Effects & Drug Interactions SIDE EFFECTSThe following adverse reactions have been reported in the mother:
Excessive dosage or hypersensitivity to the drug may result in uterine hypertonicity, spasm, titanic contraction, or rupture of the uterus. The possibility of increased blood loss and afibrinogenemia should be kept in mind when administering the drug. Severe water intoxication with convulsions and coma has occurred, associated with a slow oxytocin infusion over a 24-hour period. Maternal death due to oxytocin-induced water intoxication has been reported. The following adverse reactions have been reported in the fetus or neonate:
For medical advice about adverse reactions contact your medical professional. To report SUSPECTED ADVERSE REACTIONS, contact Par Pharmaceutical at 1-800-828-9393 or FDA at 1-800-FDA-1088 (1-800-332-1088) or www.fda.gov/medwatch. DRUG INTERACTIONSSevere hypertension has been reported when oxytocin was given three to four hours following prophylactic administration of a vasoconstrictor in conjunction with caudal block anesthesia. Cyclopropane anesthesia may modify oxytocin's cardiovascular effects, so as to produce unexpected results such as hypotension. Maternal sinus bradycardia with abnormal atrioventricular rhythms has also been noted when oxytocin was used concomitantly with cyclopropane anesthesia. SLIDESHOW16 Early Signs & Symptoms of Pregnancy: Could You Be Pregnant? See SlideshowWARNINGSPitocin, when given for induction of labor or augmentation of uterine activity, should be administered only by the intravenous route and with adequate medical supervision in a hospital. PRECAUTIONSGeneral
Nonclinical ToxicologyCarcinogenesis, Mutagenesis, Impairment Of FertilityThere are no animal or human studies on the carcinogenicity and mutagenicity of this drug, nor is there any information on its effect on fertility. PregnancyTeratogenic EffectsAnimal reproduction studies have not been conducted with oxytocin. There are no known indications for use in the first trimester of pregnancy other than in relation to spontaneous or induced abortion. Based on the wide experience with this drug and its chemical structure and pharmacological properties, it would not be expected to present a risk of fetal abnormalities when used as indicated. Nonteratogenic EffectsSee ADVERSE REACTIONS in the fetus or neonate. Labor And Delivery See INDICATIONS AND USAGE section. Overdose & Contraindications OVERDOSEOverdosage with oxytocin depends essentially on uterine hyperactivity whether or not due to hypersensitivity to this agent. Hyperstimulation with strong (hypertonic) or prolonged (tetanic) contractions, or a resting tone of 15 to 20 mmHg or more between contractions can lead to tumultuous labor, uterine rupture, cervical and vaginal lacerations, postpartum hemorrhage, uteroplacental hypoperfusion, and variable deceleration of fetal heart, fetal hypoxia, hypercapnia, perinatal hepatic necrosis or death. Water intoxication with convulsions, which is caused by the inherent antidiuretic effect of oxytocin, is a serious complication that may occur if large doses (40 to 50 milliunits/minute) are infused for long periods. Management consists of immediate discontinuation of oxytocin and symptomatic and supportive therapy. CONTRAINDICATIONSAntepartum use of Pitocin is contraindicated in any of the following circumstances:
CLINICAL PHARMACOLOGYUterine motility depends on the formation of the contractile protein actomyosin under the influence of the Ca2+- dependent phosphorylating enzyme myosin light-chain kinase. Oxytocin promotes contractions by increasing the intracellular Ca2+. Oxytocin has specific receptors in the myometrium and the receptor concentration increases greatly during pregnancy, reaching a maximum in early labor at term. The response to a given dose of oxytocin is very individualized and depends on the sensitivity of the uterus, which is determined by the oxytocin receptor concentration. However, the physician should be aware of the fact that oxytocin even in its pure form has inherent pressor and antidiuretic properties which may become manifest when large doses are administered. These properties are thought to be due to the fact that oxytocin and vasopressin differ in regard to only two of the eight amino acids (see PRECAUTIONS section). Oxytocin is distributed throughout the extracellular fluid. Small amounts of the drug probably reach the fetal circulation. Oxytocin has a plasma half-life of about 1 to 6 minutes which is decreased in late pregnancy and during lactation. Following intravenous administration of oxytocin, uterine response occurs almost immediately and subsides within 1 hour. Following intramuscular injection of the drug, uterine response occurs within 3 to 5 minutes and persists for 2 to 3 hours. Its rapid removal from plasma is accomplished largely by the kidney and the liver. Only small amounts are excreted in urine unchanged. PATIENT INFORMATIONNo information provided. Please refer to the WARNINGS and PRECAUTIONS sections. FromReport Problems to the Food and Drug AdministrationYou are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088. What is the nursing considerations for Pitocin?Monitoring. Electronically monitor the uterine activity and the fetal heart rate throughout the infusion of Pitocin. Attention should be given to tonus, amplitude and frequency of contractions, and to the fetal heart rate in relation to uterine contractions.
What nursing responsibilities are involved during the administration of oxytocin during labor?Now, nurses are responsible for safely administering oxytocin during labor, avoiding excessive stimulation to the uterus or harm to the fetus. So, before starting the infusion, be sure to review the client's medical record to be sure there are no contraindications to administration.
Which of the following is your nursing responsibility before administration of oxytocin?The nurse must have sound knowledge about the physiology of uterine contractions and the phamacodynamics and pharmacokinetics of oxytocin. In addition, the nurse must be proficient at maternal-fetal assessment, including palpation of contractions and interpretation of electronic fetal heart rate monitor tracings.
What should I check before giving Pitocin?Certain conditions prevent the use Pitocin, including:. You've had a prior C-section with a classical incision or major uterine surgery.. The placenta is blocking your cervix (placenta previa). Your baby is in a breech or transverse position.. You have an active genital herpes infection.. You have an umbilical cord prolapse.. |