OXYTOCIN

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Oxytocin:

  • It is a posterior pituitary hormone and it increases uterine motility.
  • Oxytocin is a nonapeptide secreted by the posterior pituitary along with vasopressin (ADH).
  • It increases the force and frequency of uterine contractions.
  • It is also known as love hormone.
what are the usage of oxytocin.

  1. Induction of labour:
  • Labour needs to be induced in case of postmaturity or prematurely in toxaemia of pregnancy, diabetic mother, erythroblastosis, ruptured membranes or placental insufficiency. For this purpose oxytocin is given by slow i.v. infusion: 5 IU is diluted in 500 ml of glucose or saline solution (10 milli IU/ml)— infusion is started at a low rate and progressively accelerated according to response (0.2–2.0 ml/ min). Before starting infusion, confirm that:
  • presentation is correct
  • foetal lungs are adequately mature
  • there is no cephalopelvic disproportion
  • no placenta previa
  • no foetal distress and
  • no uterine scar (due to previous surgery).
  • Uterine contractions are then closely monitored: the drug is discontinued when they are strong enough. Usually a total of 2–4 IU is needed.
  1. Uterine inertia:
  • When uterine contractions are feeble and labour is not progressing satisfactorily—oxytocin can be infused i.v.
  • It should not be used to hasten normally progressing labour. Before deciding to use an oxytocic for strengthening uterine contractions, all the conditions as setout above (for induction of labour) must be fulfilled.
  1. Postpartum haemorrhage, Caesarean section:
  • Oxytocin 5 IU may be injected i.m. or by i.v. infusion for an immediate response, especially in hypertensive women in whom ergometrine is contraindicated. It acts by forcefully contracting the uterine muscle which compresses the blood vessels passing through its mesh work to arrest haemorrhage from the inner surface exposed by placental separation.
  1. Breast engorgement:
  • It may occur due to inefficient milk ejection reflex. Oxytocin is effective only in such cases; an intranasal spray may be given few minutes before suckling. It does not increase milk production.
  1. Oxytocin challenge test:
  • It is performed to determine uteroplacental adequacy in high risk pregnancies. Oxytocin is infused i.v. at very low concentrations till uterine contractions are elicited every 3–4 mins. A marked increase in foetal heart rate indicates uteroplacental inadequacy. The test is risky and is rarely performe:
what are the adverse effects:

(i) Injudicious use of oxytocin during labour can produce too strong uterine contractions forcing the presenting part through incompletely dilated birth canal, causing maternal and foetal soft tissue injury, rupture of uterus, foetal asphyxia and death.

(ii) Water intoxication: This occurs due to ADH like action of large doses given along with i.v. fluids, especially in toxaemia of pregnancy and renal insufficiency. It is a serious (may be fatal) complication.

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