Oxytocin

Oxytocin – synthetic hormonal drug for stimulation of patrimonial activity.

Form of release and structure

Dosage form – solution for intramuscular (in oil) and intravenous (in/in) introductions: transparent colourless liquid without mechanical inclusions (on 1 ml in glass ampoules, in a cardboard pack of 5 ampoules).

Active agent – oxytocin, in 1 ampoule – 5 international units (ME).

Auxiliary components: ethanol (96%), chlorbutanol гемигидрат, acetic acid ice, water for injections.

Indications to use

• Stimulation of patrimonial activity in the first and second periods of childbirth at weakness (primary or secondary) labor pains;
• Rodovozbuzhdeniye on late or close to it to the pregnancy period, in case of need early childbirth in connection with a pre-natal arrest of development of a fruit, a Rhesus factor conflict, a gestosis, a premature or precocious rupture of covers of a fruit and izlitiy amniotic waters, pre-natal death of a fruit, postmature pregnancy (after 42 weeks);
• Prevention and treatment of hypotonic bleedings after abortion, childbirth, Cesarean section (after the birth of the child and department of an afterbirth) (for the purpose of acceleration of puerperal involution of a uterus);
• Additional therapy at cancelled or incomplete abortion.

Contraindications

• Narrow basin of the woman in labor (discrepancy of the sizes of a basin and head of a fruit), presentation or prolapse of the umbilical cord, partial or full placental presentation, the slanting and cross provision of a fruit preventing spontaneous delivery;
• The emergency situations demanding an operative measure, caused by a condition of a fruit or the woman in labor;
• Uterus hyperdystension;
• Front presentation;
• Fruit prelum;
• Uterine sepsis;
• Fruit distress long before approach of terminal durations of gestation;
• Heavy gestosis (renal failure, high arterial pressure), the uterus hyper tone (which appeared before childbirth);
• Heart diseases, arterial hypertension;
• Renal failure;
• Breastfeeding period;
• Hypersensitivity to oxytocin and other components of drug.

Drug is contraindicated for prolonged use at passivity of a uterus.

Except special circumstances, use of Oxytocin is also contraindicated in case of polycarpous pregnancy, premature births, a hyper tone of a uterus, existence in the anamnesis of extensive surgical intervention on a uterus and a neck of uterus (including Cesarean section), an invasive stage of a carcinoma of a neck of uterus.

Route of administration and dosage

Solution is applied in the way in/in also by introductions in oil.

For artificial initiation and stimulation of strengthening of patrimonial activity the drug is administered exclusively intravenously in the conditions of a hospital with use of the special equipment providing the corresponding medical control.

It is impossible to enter at the same time solution in/in and in oil.

The dose is appointed a trial and error method taking into account individual portability of the woman in labor and a fruit.

Introduction of oxytocin for a rodovozbuzhdeniye and stimulation of labor pains is made intravenously using an infusional pomp and the special equipment allowing to monitor cordial activity of a fruit and force of uterine reductions.

At excessive strengthening of sokratitelny activity of a uterus infusion needs to be stopped immediately for bystry decrease in a sokratitelny uterine activity.

Rodovozbuzhdeniye is begun with introduction of pure normal saline solution. Then start standard infusion, having dissolved 1 ml of oxytocin in 1000 ml of not hydrating liquid and having carefully mixed. Initial rate of administering – from 2 to 16 drops a minute. For achievement of desirable degree of a sokratitelny uterine activity every 20-40 minutes speed is increased on 4-8 drops. When uterine reductions begin to correspond to natural patrimonial activity, and disclosure of a pharynx of a uterus reaches 4-6 cm, in the absence of symptoms of a fetalis distress gradual reduction in the rate of infusion upside-down, corresponding to its acceleration is recommended.

Infusion speed on late durations of gestation should not exceed 32-36 drops a minute, except for exceptional cases.

At premature births use of high rate of administering of drug, sometimes to 80 drops a minute is possible.

Infusion should be accompanied with regular careful control of heartbeat of a fruit, uterus tone at rest, frequencies, forces and durations of its reductions.

At a uterine hyperactivity or a fetalis distress introduction of oxytocin should be stopped immediately, to provide oxygen therapy to the woman in labor and control of her state and fruit by the specialist doctor.

For prevention and treatment of hypotonic bleedings in a puerperal period intravenous infusion of 2-8 ml of Oxytocin dissolved in 1000 ml of not hydrating liquid is shown, prevention of a uterine atony requires usually 80-160 drops a minute.

After department of a placenta in oil enter 1 ml of oxytocin.

At incomplete or cancelled abortion to the patient in/in kapelno with a speed of 20-40 thaws a minute enter 2 ml of drug divorced in 500 ml of normal saline solution or mix from 5% of a dextrose and normal saline solution.

Side effects

• Reproductive system: at high doses or hypersensitivity – a uterus hyper tone, a tetany, a spasm, a hysterorrhesis, strengthening of bleeding after the delivery (because of thrombocytopenia, prothrombinopenias or afibrinogenemiya caused by oxytocin); sometimes – hemorrhages in bodies of a small pelvis;
• Alimentary system: nausea, vomiting;
• Cardiovascular system: at high doses – ventricular premature ventricular contraction, arrhythmia, a heavy hypertension (against the background of use of angiotonic means), hypotonia (at a combination to anesthetic cyclopropane), reflex tachycardia, shock; at high rate of administering – subarachnoidal bleeding, bradycardia;
• Water and electrolytic exchange: at long (24 hours) slow in introduction emergence of the heavy overhydratation (usually at a high speed of infusion) proceeding with spasms and a coma is possible; seldom – a lethal outcome;
• Immune system: development of allergic reactions (including an anaphylaxis); at high rate of administering – a bronchospasm; seldom – a lethal outcome.

Besides, use of Oxytocin for a rodovozbuzhdeniye Apgar can cause side effects in a fruit or the newborn in the form of jaundice of newborns, a low mark within 5 minutes on a scale; at high rate of administering – an eye retinal apoplexy, reduction in fibrinogen fruit blood; when strengthening a sokratitelny uterine activity – residual changes of the central nervous system, arrhythmia (including tachycardia, a sinus bradycardia, ventricular premature ventricular contraction), death of a fruit as a result of asphyxia.

Special instructions

Use of Oxytocin should be begun after careful assessment of the expected therapeutic effect with possible risk of development of a tetany and hyper tone of a uterus.

The odynagogue cannot be begun until emergence of a head of a fruit in an entrance to a basin.

Intravenous administration of oxytocin has to be carried out in the conditions of a hospital under constant control of experienced specialists whose qualification allows to define the first symptoms of complications and to give immediate help. Careful regular control of delivery reduces risk of bleedings after the delivery.

To avoid complications, the entire period of administration of drug should be accompanied with control of cordial activity of mother and a fruit, dynamics of uterine reductions, arterial pressure of the woman in labor.

Adequate use of oxytocin has to cause reductions of a uterus, similar to spontaneous childbirth. The wrong use of drug is dangerous both to the woman in labor, and to a fruit.

Danger of excessive reductions of a uterus can arise at hypersensitivity of a uterus to oxytocin.

It is necessary to consider risk of development of an afibrinogenemiya and increase in blood losses.

Oxytocin has antidiuretic effect therefore at continuous infusion and at additional oral administration of liquid the possibility of development of an overhydratation increases.

Drug can be mixed with solutions of sodium of chlorate, sodium of a lactate and glucose. Ready infusion solution needs to be used within the first 8 hours.

Oxytocin does not exert impact on ability to control of vehicles and mechanisms.

Medicinal interaction

Development of the expressed arterial hypertension at use of oxytocin in 3-4 hours after administration of caudal anesthesia together with vasoconstrictors is possible.

The drug combination to a halothane, cyclopropane can cause change of its cardiovascular action and to become the reason of unexpected development in the woman in labor of arterial hypotension, sinus bradycardia and an atrio-ventricular rhythm during anesthesia.

Terms and storage conditions

To protect from children.

To store in the place protected from light at a temperature from 2 to 15 °C.

Period of validity – 3 years.