Oxytocin (Intramuscular, Intravenous)

Overview

Beginning the process of starting childbirth can sometimes be difficult and pregnant women often need to have labor induced for a number of reasons. Oxytocin is an injected hormone that is used to start this process or help it along if difficulties are experienced in the middle of labor. It can also be used to control bleeding if the amount of bleeding is concerning or projected to be severe. It may also be used to help increase milk secretion for the purpose of breastfeeding.

As a versatile hormonal treatment, Oxytocin may be prescribed by a doctor for a number of reasons that are not related to childbirth. However, when used for this primary purpose it should not be used to induce labor unless there is a specific medical reason why childbirth cannot be allowed to begin normally. This should be discussed at length with the patient before this medicine is injected. Marketed under the brand name Pitocin, Oxytocin is a prescription-only medication that is available in the form of an injectable solution. Previously, there was a nasal spray of Oxytocin named Syntocinon that was removed from the market and is no longer available.

Condition treated

  • Childbirth
  • Bleeding

Type Of Medicine

  • Hormone

Side Effects

As with many medications, there can be some unwanted side effects associated with taking Oxytocin. These side effects may not be very likely, but a patient should be appraised of their incidence prior to taking the injection to induce childbirth. If these side effects occur they may result in complications that can make childbirth or recovery more difficult. Some of the more rare but serious side effects include potentially life-threatening conditions. Emergency medical care should be summoned if a patient demonstrates any of the following symptoms when taking
Oxytocin:

  • Confusion
  • Convulsions
  • Difficulty breathing
  • Dizziness
  • Fast or irregular heartbeat
  • Severe headache
  • Hives
  • Pelvic or abdominal pain
  • Skin rash or itching
  • Increased vaginal bleeding
  • Weakness
  • Sudden weight gain

Other side effects have been reported when using Oxytocin although its incidence is not known. Some of the following severe side effects may occur and call for emergency medical attention.

  • Abdominal pain or cramping
  • Blood clotting problems
  • Chest pain or discomfort
  • Cough
  • Difficulty swallowing
  • Extra heartbeats
  • Fainting
  • Lightheadedness
  • Pounding or rapid pulse
  • Puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  • Severe bleeding after giving birth
  • Shortness of breath
  • Tightness in the chest
  • Unusual tiredness or weakness
  • Wheezing

Along with these side effects, there is a certain risk of overdose that is characterized by specific symptoms. Contact emergency medicine if any of the following symptoms occur when using Oxytocin:

  • Restlessness
  • Shakiness
  • Sleepiness
  • Slow to respond
  • Slurred speech
  • Unconsciousness

While these serious side effects require medical attention, some side effects of Oxytocin are considered routine and may not necessarily be very serious. Some are only temporary and will subside as the body gets used to Oxytocin in the system. If there are concerns or the side effects are bothersome talk to a doctor about some potential remedies to ride out the symptoms until they go away. If they are stronger than normal or persist longer, they may be indicative of a more serious health condition and should be discussed with a doctor. The most common of these temporary side effects are nausea or vomiting although other gastrointestinal distress has also been reported. If any symptoms are experienced that are not on this list they should also be discussed with a physician as this list does not denote all the possible side effects that Oxytocin may cause.

Dosage

Oxytocin is only to be administered by a trained medical professional such as a doctor or nurse. It is injected through a needle that is placed in the vein or a shot directly into a large muscle group. The dosage that is required is different for every case as it is determined by the amount of uterine response to the injection. When used for the stimulation or induction of labor, it is administered as an intravenous drip. This drip must be closely monitored by the prescribing physician as accurate control of the infusion is crucial. This must be done with a great deal of consideration for the strength of contractions and the fetal heart rate. If contractions become too intense or there is any disruption of the fetal heart rate the infusion must be stopped immediately. This is usually followed by a second infusion of a solution that does not contain the oxytocin.

The average patient will start with an intravenous drip of 1ml per 1000ml of diluent. The initial dose should not exceed 1-2ml per minute. However, this may be gradually increased in 1-2ml increments until the desired contraction pattern has been established and a normal progression of labor is possible. If uterine hyperactivity or fetal distress is detected the drip should be immediately terminated and oxygen should be administered to the mother under the supervision of the attending physician.

When used for the control of postpartum uterine bleeding the intravenous drip of Oxytocin may vary from 10-40 units per 1000ml of diluent that is run at a rate that is dependant upon the severity of the bleeding being experienced. The bleeding may also be treated with an intramuscular injection that consists of 1ml administered after delivery of the placenta.

Interactions

Some medicines should not be used at the same time, and Oxytocin has known reactions with certain medications which may be in the system when labor begins. In some cases, this risk must be taken when the risk of delayed labor is more significant but in these cases certain precautions may be taken including altering doses or the rate of infusion. The prescribing physician should be aware of all prescription and over the counter medications that are being taken with Oxytocin. There may also be reactions with food or drink consumed at the same time as the treatment as well as the use of alcohol or tobacco. Use of these products should be discussed with a physician before a dose of Oxytocin is administred.

Certain medical problems will cause a hazardous condition when oxytocin is administered and the medication may make these conditions worse. Additionally, certain medical conditions can affect the way that oxytocin works. The prescribing physician should be aware if the patient has any of the following conditions:

  • Bleeding problems
  • Hypertension
  • Cephalopelvic disproportion
  • Cervical cancer
  • Fetal distress
  • Grand multiparity
  • Major surgery on the cervix or uterus
  • Overdistended uterus
  • Premature fetus
  • Problems with uterine contraction
  • Toxemia
  • Unfavorable fetal position
  • Other conditions that may require cesarean delivery
  • Kidney disease

Warnings

Oxytocin is a very useful medication for helping women in the middle of a difficult labor experience, but the patient should be aware of certain risks that are incurred by beginning the induction process. Oxytocin's purpose is to cause contractions in the uterus but in some women with a higher degree of sensitivity these contractions may become too strong. Conditions caused by these powerful contractions include injuries such as the tearing of the uterus or a disruption of blood and/or oxygen to the fetus. Women taking this hormone should also be aware of the potential of the medication to alter milk production or composition. In some cases, this may be the intended result but if this a concern for the health of the infant an alternative medication should be considered. Some newborn infants have experienced jaundice and eye problems such as retinal hemorrhage after being birthed with the assistance of Oxytocin. There is also a risk of water intoxication when taking oxytocin. The patient or caregiver should immediately call for medical assistance if the mother becomes confused, experience severe headaches, or have a seizure while using this medication.

Storage

This medication will be stored by medical professionals in a hospital environment. As a solution, it will normally be kept in accordance with world health organization guidelines under refrigeration as much as possible. The solution should be marked to be kept refrigerated except for brief periods of transport in temperatures not to exceed 30 degrees Celsius.

Summary

Oxytocin is often prescribed to induce a pregnancy when other options are not feasible. While very useful when treating women who need to induce difficult pregnancies, there are many risks associated with inducing labor with Oxytocin. In some cases, an induced pregnancy can be much more painful and traumatic than if they were allowed to proceed naturally. So long as it is used judiciously and there are significant medical reasons why the natural course of labor or a caesarian section would be dangerous then this medication may represent the best hope for a successful childbirth.