II. Indications
- Labor Induction or Labor Augmentation
- Prevention of Postpartum Hemorrhage
III. Physiology
- Oxytocin is a hypothalamic polypetide stored in the posterior Pituitary Gland
- Oxytocin release is triggered by reflex response to Hypothalamus from infant sucking nipple
- Oxytocin effects
- Stimulates uterine contractions
- Stimulates milk ejection in lactating women
IV. Adverse Effects
- Uterine hypertonicity
- Uterine tetanic contractions and Fetal Distress
- Uterine Rupture
-
Water Intoxication (SIADH)
- Associated with slow infusion >24 hours
V. Pharmacokinetics: Intravenous Oxytocin
- Onset: 1 minute
- Duration: 30 minutes
- Half-life: <5 minutes
VI. Dosing: Labor Induction or Labor Augmentation
- See Labor Induction
- Preparation: Oxytocin in Normal Saline Infusion
- Oxytocin 10 units in 1000 ml Normal Saline
- Starting rate of 6-12 ml/hour delivers 1-2 mU/minute
- Increasing rate 6 ml/hour delivers another 1 mU/min
- Oxytocin 20 units in 1000 ml Normal Saline
- Starting rate of 3-6 ml/hour delivers 1-2 mU/minute
- Increasing rate 3 ml/hour delivers another 1 mU/min
- Oxytocin 10 units in 1000 ml Normal Saline
- Protocol: Low Dose (preferred)
- Start: 0.5 to 2 mIU/minute
- Increase: 1-2 mU/minute every 15-40 minutes
- Base Pitocin rate changes on contractions
- After 8 mIU/minute, may then increase by 2 mIU/minute
- Maximum: 40 mIU/minute
- Protocol: High Dose
- Low dose protocol is preferred in all patients (see Labor Induction for efficacy)
- Use only in Nulliparous patients only
- See Monitoring below
- Start: 6 mIU/minute
- Increase: 3-6 mIU/minute every 15-40 minutes
- Maximum: 40-42 mIU/minute
- As of 2019, evidence is against the use of high dose Oxytocin (see Labor Induction for efficacy)
VII. Dosing: Postpartum Hemorrhage Management and Prophylaxis
-
Postpartum Hemorrhage prevention after Vaginal Delivery
- Oxytocin 10 units IM after delivery
- Oxytocin 10-40 units in 1 L IV fluid (NS, LR, D5W)
-
Postpartum Hemorrhage prevention after cesarean
- High dose Oxytocin prevents atony
- Dose: Oxytocin 2667 mU/min for 30 minutes
- Munn (2001) Obstet Gynecol 98:386-90 [PubMed]
VIII. References
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Related Studies
| Definition (MSH) | A nonapeptide hormone released from the neurohypophysis (PITUITARY GLAND, POSTERIOR). It differs from VASOPRESSIN by two amino acids at residues 3 and 8. Oxytocin acts on SMOOTH MUSCLE CELLS, such as causing UTERINE CONTRACTIONS and MILK EJECTION. |
| Definition (NCI) | Oxytocin (125 aa, ~13kDa) is encoded by the human OXT gene. This protein plays a role in smooth muscle contraction in both the mammary gland and uterus. Oxytocin also is involved in maternal-newborn bonding, cognition and many other psychological and physiological processes. |
| Definition (CSP) | peptide hormone produced by the posterior lobe of the pituitary gland that induces contraction of the smooth muscle of the uterus and the myoepithelial cells of the mammary gland. |
| Concepts | Pharmacologic Substance (T121) , Hormone (T125) , Amino Acid, Peptide, or Protein (T116) |
| MSH | D010121 |
| SnomedCT | 12369008, 112115002 |
| LNC | LP15767-4, MTHU013002 |
| English | Ocytocin, Oxytocin, Cys-Tyr-Ile-Gln-Asn-Cys-Pro-Leu-Gly-NH2, cyclic 1-6 disulfide, oxytocin, oxytocics oxytocin, oxytocin (medication), OXYTOCIN, Oxytocin [Chemical/Ingredient], ocytocin, Oxytocin preparation, Oxytocin product, Oxytocin (substance), Oxytocin preparation (product), Oxytocin preparation (substance), OXT |
| Swedish | Oxytocin |
| Spanish | preparado de oxitocina, preparado con oxitocina (producto), preparado con ocitocina, oxitocina (producto), preparado con oxitocina, ocitocina, oxitocina (sustancia), oxitocina, preparado de oxitocina (sustancia), preparado de ocitocina, preparado de oxitocina (producto), Oxitocina |
| Czech | oxytocin |
| Finnish | Oksitosiini |
| French | Oxytocine, Ocytocine |
| Russian | 3-IZOLEITSIN,8-LEITSIN-VAZOPRESSIN, OTSITOTSIN, VAZOPRESSIN, IZOLEITSIL-LEITSIL, OKSITOTSIN, IZOLEITSIL, LEITSIL-VAZOPRESSIN, AL'FA-GIPOFAMIN, VAZOTOTSIN, LEITSIL, 3-ИЗОЛЕЙЦИН,8-ЛЕЙЦИН-ВАЗОПРЕССИН, АЛЬФА-ГИПОФАМИН, ВАЗОПРЕССИН, ИЗОЛЕЙЦИЛ-ЛЕЙЦИЛ, ВАЗОТОЦИН, ЛЕЙЦИЛ, ИЗОЛЕЙЦИЛ, ЛЕЙЦИЛ-ВАЗОПРЕССИН, ОКСИТОЦИН, ОЦИТОЦИН |
| Japanese | オシトシン, オキシトシン |
| Croatian | OKSITOCIN |
| Polish | Oksytocyna, Ocytocyna |
| Norwegian | Oxytocin, Oksytocin |
| Portuguese | Oxitocina, Ocitocina |
| German | Ocytocin, Oxytocin |
| Italian | Ossitocina |
Ontology: Pitocin (C0733348)
| Concepts | Pharmacologic Substance (T121) , Hormone (T125) , Amino Acid, Peptide, or Protein (T116) |
| MSH | D010121 |
| French | Pitocine |
| English | pitocin, Pitocin |
| Norwegian | Pitocin |
