Oxytocin method of administration. Features of the use of oxytocin. Interaction with other medications

The physiological state of a person largely depends on the hormonal background. One of the important hormones is oxytocin with an oligopeptide structure. In men, under its influence, parochial altruism increases, emotional (spiritual) ties in relation to loved ones are strengthened. In women, there is a suppression of anxiety and a feeling of fear, stimulation of the contractility of the uterus, which is important during childbirth to facilitate the passage of the fetus through the birth canal.

What does oxytocin, the hormone of love and affection, consist of and how does it work, what are known ways to increase it with insufficient concentration, we will consider later in the article.

Oxytocin, what kind of drug?

Oxytocin is a substance, the production of which in men and women is produced by the hypothalamus with subsequent transportation to the posterior lobe of the pituitary gland. The influence of oxytocin on the psychoemotional background of people has been proven. Also, on the basis of this hormone, pharmaceutical companies published the drug Oxytocin with the same name. If earlier in medicine, a substance obtained from animals was used. Today, the hormone is exclusively synthetic and has found wide application in gynecology with the introduction of injections into the muscle of the uterus.

If the natural production of oxytocin in hormonal background insufficient production, the hormone can be prescribed to women:

• during childbirth in case of weak contractions of the uterus;
• during a cesarean section;
• in the postnatal period in order to normalize the contractility of the uterus, eliminate bleeding, improve the excretion of milk from the mammary glands during lactation;
• for early termination of pregnancy.

Composition and form of release

Oxytocin is produced in solutions for injection (i / v, i / m). On appearance this is:

• transparent sterile liquid;
• without any special smell and color.

The composition of 1 ampoule contains:

• oxytocin (5 IU);
• additional elements: chlorobutanol hydrate, purified water.

Properties

Oxytocin is considered a complex hormone in structure, but very important with the production of the hypothalamus in the brain. It has extremely positive properties on a person:

• increases the emotional background;
• reduces stress, anxiety, fears, anxiety;
• enhances emotional memory;
• enhances sexual desire, since it is able to increase in concentration when hugging, kissing, touching;
• helps people adapt in society, regulates communication;
• suppresses drug addiction, cravings for smoking, cocaine, alcohol;
• has a calming effect, normalizes sleep;
• stimulates in a person the most best qualities: generosity, cordiality, hospitality;
• activates the body's defenses, begins to show aggression to the onslaught of irritants.

Protein-derived oxytocin plays an important role for women:

• contributes to the regulation of behavioral reactions in women during pregnancy;
• stimulates the birth process;
• has a relaxing effect on vascular smooth muscles, leading to a short-term decrease in pressure indicators;
• has a selective effect on the myometrium in the uterine cavity, since it does not contain hormones in the composition of other impurities;
• has a beneficial effect on the uterus and mammary glands;

• normalizes blood pressure;
• relaxes vascular muscles;
• facilitates the labor process in women, begins to stimulate the contractility of the uterus and the production of breast milk, to prevent the development of stagnation;
• enhances the secretion of prolactin, which begins to produce breast milk and accelerate the patency of the milk ducts;
• strengthens the bond between mother and child.

REFERENCE! In the course of the studies, it was revealed that the concentration of oxytocin in different phases of the menstrual cycle in women in the blood practically does not change. Even during pregnancy in the 2-3 trimester, with an unstable hormonal background, it can only slightly increase at night.

Pharmacology and pharmacokinetics

Mechanisms of action Oxytocin is due to the effect on the cells of the myometrium, leading to an increase in the excitability and permeability of their membranes for potassium ions. This is how the stimulation of the uterus and the production of lactogenic hormone in women begins.

The action of the drug is observed immediately, approximately 3-5 after administration. After 1 hour, it begins to gradually decrease. Although the effect may be individual, since the density of uterine muscle cells and oxytocin receptors is different for each woman.

The absorption of the drug into the bloodstream is fast. Metabolization of active particles occurs in the liver. The excretion process is carried out by the kidneys.

REFERENCE! Oxytocin is unable to exert a pronounced antidiuretic effect and does not affect blood pressure. It is practically free of proteins, therefore it does not lead to anaphylactic reactions when administered intravenously.

The drug has a powerful abortive effect. Able to provoke miscarriage or contractions in women before childbirth.

Indications for use

Oxytocin actively stimulates labor activity, therefore it is prescribed in the following cases:

• contractions to stimulate the uterine cavity;
• cesarean section;
• atonic bleeding;
• delayed uterine discharge in the postpartum period;
• the need for early birth due to intrauterine fetal growth retardation;
• conflict Rh factor;
• gestosis;
• intrauterine fetal death;
• prolonged pregnancy over 42 weeks;
• preventive measures after childbirth or abortion for hypotonic bleeding;
• performing a defective (failed) abortion as an additional therapy.

Indications for the administration of oxytocin infusions for the purpose of carrying out an induced (medical) abortion:

• fetal malformation;
• frozen pregnancy.

The introduction of the drug in order to suppress pregnancy is carried out only in medical institutions and under the supervision of doctors. First, it is extremely important to make sure that the fertilized egg has left the uterine cavity. Doctors need to track the contractile functions of the uterus and the general well-being of women, since after the administration of oxytocin, there is a high likelihood of bleeding.

Contraindications

Oxytocin is a drug that must be used exclusively under the supervision of doctors. Self-medication is excluded.

As a rule, the drug is administered to women to initiate, stimulate labor, but there are contraindications to use as a birth stimulator:

• incorrect (transverse, frontal) presentation of the fetus with the impossibility of leaving the head through the birth canal in a natural way, when doctors resort to a cesarean section;
• discrepancy between the size of the pelvis and head;
• identification of hydrocephalus in the case of brain pathology in the fetus;
• high chance of bleeding;
• the threat of rupture of the uterus, which poses a danger to the life of the fetus and mother;
• excessive sensitivity to the active substances of oxytocin;
• narrowness of the pelvis in women in labor;
• immaturity of the cervix;
• the appearance of hyperstimulation after the injected oxytocin;
• premature birth;
• prolapse of the umbilical cord;
• severe gestosis;
• sepsis or severe distension of the uterus;
• heart disease (arterial hypertension);
• impaired renal function.

The note! In order to terminate pregnancy, the administration of oxytocin is contraindicated in a woman with fibroids or scars on the cervix.

Overdose

An overdose of the drug when administered intramuscularly can cause:

• hyperstimulation, prolonged contractions of the uterus;
• rapid childbirth, which can negatively affect the body of women in the event of an artificial termination of pregnancy due to Oxytocin.

In case of an overdose of oxytocin, it is necessary to carry out urgent rehydration actions:

• cancel the administration of infusions;
• limit fluid intake;
• correct the water-electrolyte balance;
• stop seizures with barbiturates if necessary.

REFERENCE! An overdose of oxytocin provokes damage to the vagina and rupture of the cervix (body) of the uterus as a result of hyperactivity, severe bleeding, the development of cardiac pathologies, hypoxia in the fetus up to death.

Side effects

Negative side effects can occur in case of an overdose of Oxytocin or with excessive sensitivity of the uterus to the active ingredient.

In particular, unpleasant symptoms can be caused by reproductive system when:

• administration of the drug in large doses;
• hypersensitivity of the uterus.

Possible side signs:

• spasms, rupture of the uterus;
• bleeding;
• thrombocytopenia;
• hemorrhage in the pelvic organs.

Incorrect administration of the drug or high doses causes negative manifestations from:

• digestive system in the form of vomiting, nausea;
• cardiovascular system with the development of hypotension, arrhythmia, ventricular premature beats, tachycardia, bradycardia.

If you introduce Oxytocin slowly and for a long time, then a malfunction of the water-electrolyte balance may occur, appear in women:

• convulsions;
• allergic reactions;
• bronchospasm;
• anaphylaxis up to death;
• coma.

Oxytocin should only be used under the strict guidance of a specialist, as it can lead to side effects not only in women, but also in the fetus. So if the drug is administered at a high speed, then jaundice and retinal hemorrhage in a newborn are possible.

The note! Improper administration can cause fetal asphyxia and death. If the drug is administered by pregnant women at home, then the following signs should be the reason for urgent cancellation: pressure surges, spasms in the bronchi, sensation of the uterus, itching and rash on the body, swelling of the tongue, difficulty breathing, convulsions, slow heartbeat.

Instructions for use

It is best to inject the Oxytocin solution intramuscularly. If the detailed option does not lead to the expected results, then you can switch to the introduction into a vein, but rather slowly.

Average dosage for 1 session is 1-3 IU. According to gynecological indications, it can be increased up to 10ME. With a cesarean section - 5ME.

For termination of pregnancy, the selection is carried out by the doctor, taking into account the duration and frequency of uterine contractions. At first, Oxytocin is injected slowly (no more than 16 drops per minute). Then you can gradually increase the speed by 48 drops after 20-40 minutes in order to achieve the desired degree of uterine contractile activity. As the uterine pharynx opens up to 6 cm, it is recommended to reduce the rate of oxytocin infusion, i.e. start injecting in the reverse order with decreasing drops.

If the drug is administered late in pregnancy, the rate of administration should not exceed 30 drops per minute. When using Oxytocin in case of premature birth, the rate should be approximately 75-80 drops per minute. At the same time, the tone and duration of contraction of the uterus, fetal heartbeat must be kept under complete control.

Oxytocin tablets are used as follows:

• placing 1 piece on the cheek without swallowing, leaving it until completely absorbed;
• taking the 2nd tablet in 30-40 minutes.

The maximum dosage per day is 500 units. If the effect of taking is absent before the medical abortion, then it is allowed to drink another 1 additional pill. If the abortion seems to be unsuccessful, then to stimulate labor, it is worth injecting the drug intravenously with a dose of 5 IU

Interaction with other medications

1. It is likely that the therapeutic effect will be reduced if oxytocin solution is used in conjunction with drugs for inhalation use under anesthesia.
2. If you combine Oxytocin with prostaglandins, then suppression of the stimulating effect and the development of arterial hypertension can be observed. The same happens when oxytocin is combined with antispasmodics (Papaverine, no-shpa).
3. It is allowed to administer the drug with glucose, sodium lactate, sodium chloride in solutions, but maintaining the intervals between doses of 6-8 hours.

Reference! Do not enter simultaneously a solution of intramuscular and intravenous Oxytocin. When choosing the optimal doses for women in labor, it is important to take into account individual tolerance, to track the strength of uterine bleeding and cardiac activity of the fetus

special instructions

1. Oxytocin is an antidiuretic, so infusion or oral pills can cause overhydration.
2. Do not use Oxytocin if you are allergic to active ingredients. Otherwise, you should be prepared for bleeding, light-headedness.
3. Improper dosage management can cause uterine rupture.
4. Stimulation of labor with Oxytocin should not be started if the fetal head only enters the pelvic region.
5. Intravenous administration of Oxytocin is necessary only in a hospital setting, so that doctors can provide the correct assistance in a timely manner. It is equally important to keep under control the dynamics of uterine contractions and cardiac activity in the mother (child).

Oxytocin can become indispensable for keeping the condition of the fetus and the birth process in women under control. But you need to enter correctly, observing the dosage, under the supervision of a specialist and cardiotocography in order to register the amplitude and frequency of contractions by the attending physician.

It happens that doctors resort to making the only correct decision about carrying out a cesarean section, when the fetus's condition changes or the drug rhodostimulation is ineffective.

In order for the delivery process to take place with the least loss for the mother and child, a decision is often made to stimulate it. With her, everything happens much faster and easier. However, the debate does not subside that this entails a lot of negative consequences for the health of a woman and her baby. A particularly strong prejudice is caused by oxytocin during childbirth, a drug that is most often given to speed up labor if it is delayed.

Is its application justified? How dangerous is its introduction into the body of a woman in labor, both for herself and for the newborn? A young mother has the right to know the answers to these exciting and important questions.

Oxytocin is a hormone produced by the body in the hypothalamus, transported to the pituitary gland (its posterior lobe), where it is actively accumulated (deposited) and then released into the blood.

Its concentration in the blood changes slightly during menstruation and pregnancy. While by the end of the 9th month, its level rises significantly and becomes maximum at night. This is directly related to the fact that it is at this time of day that most babies are born.

At the initial stage of labor, this hormone in female body smoothes the muscles of the uterus, toning it, forcing the cervix to open. After the baby is born, it increases the secretion of prolactin, which is responsible for successful lactation.

Accordingly, if doctors diagnose weak labor due to a lack of this substance, labor is stimulated with oxytocin, which speeds up delivery, making this process easier for all its participants. After everything is over, it can be set to normalize breastfeeding and faster contraction of the uterus.

Through the pages of history. In 1953, chemist Vincent Du Vigno (USA) spoke about the structure of oxytocin, and the next year he synthesized it, that is, he was able to obtain it under artificial conditions, outside of a living organism. In 1955 he was awarded Nobel Prize in the field of chemistry.

Action

In order not to be afraid of such stimulation, it is better to know in advance what specific effect oxytocin has on the female body and on the fetus during and after childbirth.

Stimulating function (to contract the uterus)

The introduction of oxytocin during childbirth is quite justified if this hormone in the female body is too small for normal delivery. It has a stimulating effect on the uterus:

• tones her smooth muscles;
• increases the tone of the myometrium;
• increases the frequency and amplitude of its contractions (if administered in small doses);
• enhances tone (if administered in high concentration);
• it is introduced to contract the uterus immediately before childbirth, as well as during the II and III periods of contractions.

The injected oxytocin before childbirth increases the strength of the woman, expands the entrance to the uterus, promotes faster birth of the baby, preventing.

Conductive function (for lactation)

Many women wonder why they inject oxytocin after childbirth, knowing only about the stimulating function of this hormone. In fact, it was he:

• contributes to the contraction of the mammary glands, due to which the milk produced under the influence of prolactin is actively excreted from the breast;
• entering the breast, it helps milk to pass freely through the ducts and painlessly stand out from the nipples;
• after the baby has absorbed milk, oxytocin is in its hypothalamus, which contributes to the normal development of the baby's central nervous system.

It should be borne in mind that the release of oxytocin during lactation contributes to moderate, but often very painful contractions of the uterus in the first weeks after childbirth. This is necessary because it helps blood to clot at the placenta attachment site. It is for this reason that oxytocin is often used to stop such a dangerous uterine bleeding.

Psychotropic function

Oxytocin soothes and sets in a positive mood, which is very important for a woman during childbirth and for further lactation. After all, it is stress that most often interferes with normal breastfeeding.

So the multifunctionality of this hormone allows it to be used during and after childbirth: oxytocin induces childbirth and activates the production of breast milk. At first glance, it seems that he has some advantages and benefits, he is so useful. But why are they increasingly talking about the negative consequences that arise after using it for stimulation? One of the reasons is a violation of medical indications.

It is interesting! Oxytocin has been shown to induce feelings of pleasure, satisfaction, calmness, and reduce anxiety. The drug is thought to affect the areas of the brain responsible for fear.

Indications

It should be understood that the use of oxytocin during and after childbirth is determined by specific medical indications, the violation of which leads to sad consequences. The hormone is administered in the following cases.

During childbirth

• , premature rupture of amniotic fluid and other pathologies that pose a risk and threat to the life and health of the mother or fetus;
• pronounced Rh factor;
• weakening or complete cessation of uterine contractions, that is, the absence of contractions (the child is immobile for an unreasonably long time in the pelvic cavity).

After childbirth

• Prevention of postpartum hemorrhage;
• insufficient.

Timely and correct administration of oxytocin in accordance with these medical indications avoids many complications. For example, prolonged presence of the fetus in the pelvic cavity can lead to severe compression of soft tissues, followed by the appearance of fistulas in the mother (genitourinary or genitourinary), as well as pressure on the baby's head, which provokes cerebrovascular accident and cerebral hemorrhage. However, as with any medicine, there are contraindications for the administration of the hormone.

Oh yes oxytocin! According to scientists, this hormone restores youthfulness to the muscles, accelerating the growth of stem cells. So its systematic introduction is safe and new way fight aging.

Contraindications

Before stimulating labor with oxytocin, the doctor should conduct an examination to identify contraindications for such medical manipulations.

Absolute contraindications

• Inconsistency in the size of the fetal head and pelvis;
• malposition;
• impossibility of delivery in a natural way (with a large fetus, hydrocephalus, frontal presentation, transverse position, umbilical cord presentation or prolapse, placenta previa);
• threatening rupture of the uterus;
• scars on the uterus after myomectomy, other surgical interventions;
• swelling of the cervix, atresia (infection of the cervix), cicatricial changes in this area, which do not allow it to open completely;
• hypersensitivity to the drug;
• hyperstimulation of the uterus with oxytocin during previous childbirth;
• immature cervix.

Relative contraindications

• Multiple pregnancy;
• uterine fibroids;

With relative contraindications, the question of stimulating labor with oxytocin is resolved with extreme caution, since in some cases this can lead to the very dangerous consequences that are so often talked about and which women in labor are so afraid of. An overdose of the drug can also lead to side effects. Therefore, it is better to find out about the hormone administration scheme in advance.

An interesting fact. High doses of oxytocin injections can reduce your susceptibility to alcohol.

Procedure progress

Oxytocin is administered during and after childbirth in different ways: intravenously, subcutaneously, intramuscularly, into the wall or cervix.

To stimulate labor, the scheme of use is as follows:

• intravenous drip infusion (that is, a conventional drip is placed);
• constant monitoring of uterine contractions in the woman in labor and cardiac activity in the fetus;
• standard dosage of oxytocin: for 500 ml of solvent (sodium chloride or glucose) - 1 ml (5 IU) of the hormone;
• speed - up to 8 drops per minute, while every 40 minutes increase by 5 drops until the desired degree of uterine contraction is achieved, then the rate decreases in the reverse order.

To stop uterine bleeding, an injection of oxytocin is given after childbirth or an IV is placed.

1. Intravenous drip injection: for 1,000 ml of solvent - up to 40 IU of the hormone.
2. Intramuscular injection: 1 ml (5 IU) after placenta separation.

For the prevention of uterine bleeding after childbirth:

• intramuscular injection of 5 IU of oxytocin up to 3 times a day for several (usually 2-3) days.

With a caesarean section:

• injection of 5 IU of oxytocin into the uterine muscle.

Many women who are facing this kind of stimulation are interested in how quickly oxytocin acts, that is, how long after its introduction, the uterus will begin to contract. The effect appears literally in a few (3-5) minutes, lasting about 3 hours.

About production. If earlier they used oxytocin, which was obtained from animals, now they use exclusively a hormone of synthetic origin.

Effects

Many women in labor are worried whether oxytocin is harmful during childbirth, both for herself and for the baby. Indeed, negative and even dangerous consequences, unwanted side effects are noted. But here you need to keep in mind two very important points. Firstly, this happens only if contraindications and dosage errors are not observed. Secondly, the consequences of this kind of stimulation are rare. So there is definitely no need for panic.

For mother

Possible consequences of oxytocin stimulation of labor for the health and life of a woman in labor if it is used incorrectly:

• arterial hypertension;
• rupture of the uterus;
• profuse bleeding after childbirth;
• hematoma in the pelvic area;
• arrhythmia, reflex tachycardia, bradycardia;
• nausea, vomiting;
• severe overhydration with coma and convulsions;
• rashes on the skin;
• anaphylactic reactions:, hypotension, shock, anaphylaxis;
• headache.

For a child

Possible consequences for the child of the introduction of oxytocin during childbirth:

• a small number of points, according to the Apgar scale (pulse, respiration, muscle tone, reflexes and skin color are determined);
• jaundice;
• hemorrhage in the retina;
• sinus bradycardia, tachycardia, arrhythmias;
• disturbances in the work of the central nervous system, brain;
• asphyxia with further lethal outcome.

According to some researchers, children who were born as a result of stimulation with oxytocin have some developmental and behavioral features throughout their lives. And although these data have not been officially confirmed, it is they who set young mothers against the introduction of this hormone during childbirth. Among the undesirable consequences in children, doctors note:

• increased neuro-reflex excitability;
• muscle hypertension;
• muscular dystonia;
• intracranial hypertension;
• minimal brain dysfunction (, attention deficit).

But again, all this manifests itself only due to the misuse of oxytocin during childbirth.

Keep in mind. Oxytocin causes drowsiness, which can adversely affect labor.

Knowing the maximum of truthful information about this drug, a woman will not be afraid of inducing labor with oxytocin, she will be able to respond to such a decision adequately and calmly. It is best to discuss this issue with your doctor in advance: are you at risk of weak labor or you can handle it yourself.

You need to understand that the dangerous consequences of the introduction of this hormone arise only in certain cases: if contraindications were not observed or the dosage regimen was violated. The modern level of medicine and the professionalism of doctors make it possible to prevent a sad development of events. So all fears and doubts in most cases are in vain.

Clear colorless liquid

Pharmacotherapeutic group

Hypothalamic-pituitary hormones and their analogues. Hormones of the posterior lobe of the pituitary gland. Oxytocin and its analogues. Oxytocin.

ATX code Н01ВВ02

Pharmacological properties

Pharmacokinetics

With intravenous administration, the effect of oxytocin occurs immediately, the intensity and frequency of uterine contractions increases gradually over 15-60 minutes and then stabilizes.

When administered intramuscularly, the effect appears after 3-5 minutes. After the termination of the intravenous infusion, the effect of the drug continues for another 20 minutes, and the labor activity of the uterus gradually decreases. Restoration of the initial state occurs after about 40 minutes, and after intramuscular administration of the drug - after 30-60 minutes. The half-life (T1 / 2) of oxytocin from blood plasma is about 1-6 minutes.

Oxytocin metabolism occurs in the liver and kidneys. The drug is excreted from the body in the form of metabolites and in small amounts unchanged, mainly in the urine.

Pharmacodynamics

Oxytocin-Biolek is a synthetic hormone similar to the natural peptide of the posterior pituitary gland. Oxytocin-Biolek stimulates the contraction of the smooth muscles of the uterus.

Under the influence of the hormone, the permeability of membranes for potassium ions increases, the membrane potential of cells decreases and their excitability increases. With a decrease in the membrane potential of cells, the frequency, intensity and duration of myometrial contractions increase.

Oxytocin-Biolek stimulates milk secretion, increasing the production of lactogenic hormone of the anterior pituitary gland (prolactin).

Oxytocin-Biolek has a weak antidiuretic effect and, in therapeutic doses, does not significantly affect blood pressure.

Indications for use

Stimulation of labor

Termination of pregnancy for medical reasons

Acceleration of postpartum uterine involution and cessation of postpartum hemorrhage

Strengthening the contractility of the uterus during cesarean section (after removal of the placenta).

Method of administration and dosage

To assess the condition of the placenta and fetus, as well as possible complications for pregnant women at high risk, an oxytocin tolerance test is performed.

For infusion, oxytocin is diluted in 500 ml of sterile 5% glucose solution or 0.9% sodium chloride solution. To stimulate labor recommends diluting 10 IU of oxytocin in 500 ml of solvent (infusion rate of 3 ml / h or 0.001 IU / min); to obtain large doses, 30 IU of oxytocin is diluted in 500 ml of solvent (infusion rate of 1 ml / h or 0.001 IU / min).

With uterine atony and to stimulate labor oxytocin is usually given by intravenous drip infusion using an infusion pump to ensure an accurate infusion rate.

Infusion begins at a rate of 0.001-0.002 IU / min, then, observing at least a 30-minute interval, the infusion rate is gradually increased until vigorous labor is established - 3-4 contractions every 10 minutes. For dose titration, fetal heart rate and uterine contractions are monitored (oxytocin cannot be administered as bolus injection). In case of fetal hypoxia and uterine hyperactivity, the oxytocin infusion should be stopped immediately.

It is believed that the rate of administration of 0.006 IU / min provides the concentration of oxytocin in the blood plasma, which corresponds to its level during natural childbirth. Usually, the required injection rate corresponds to 0.012 IU / min, but most often it is used up to 0.02 IU / min or more. Edition British National Formulary Nr. 42 recommends a maximum rate of administration of 0.032 IU / min, the maximum daily dose is 5 IU. When the required labor activity is achieved, the infusion rate is gradually reduced.

With a cesarean section (after removal of the placenta) 5 IU of the drug is injected immediately intravenously slowly.

For the prevention of hypotonic uterine bleeding (after the release of the placenta) 5 IU Oxytocin-Biolek is administered slowly intravenously; to stop bleeding - 5-10 IU, in more severe cases, 5-30 IU is administered as an infusion at a rate that prevents uterine atony. Intravenous administration of oxytocin at a high rate causes a rapid drop in blood pressure. Long-term use is undesirable (see section special instructions).

An alternative route of administration for the treatment of hypotonic uterine bleeding: 5-8 IU 2-3 times a day for 3 days intramuscularly.

For medical termination of pregnancy it is recommended to inject 5 IU of oxytocin slowly intravenously; if necessary, it is administered as an infusion at a rate of 0.02-0.04 IU / min or more.

Side effects"type =" checkbox ">

Side effects

Uterine cramps (also with small doses)

Hypertonicity of the uterus, tetanic contractions, overactive uterus with rupture of the uterus and vaginal tissues with increased sensitivity of the uterus and high doses of oxytocin

Possible: bradycardia, arrhythmias, asphyxia, acute hypoxia, death in both the mother and the fetus

Water intoxication with pulmonary edema, seizures, coma, hyponatremia, and even death when large volumes of non-electrolyte solutions are infused

Possible: nausea, vomiting, rash, and anaphylactoid reactions (shortness of breath, hypotension, or shock)

Severe hypertension can cause death, subarachnoid bleeding

Life-threatening afibrinogenemia and postpartum hemorrhage in case of complications of pregnancy and childbirth

Acute short-term hypotension with skin erythema and reflex tachycardia with high-speed intravenous oxytocin

Possible: jaundice, retinal hemorrhage in newborns

At doses exceeding 5 IU / min, oxytocin can cause short-term myocardial ischemia, depression of the ST interval, and changes in the QT interval.

Contraindications

Hypersensitivity to the drug or its components

Hypertensive uterine contractions

Fetal hypoxia

Discrepancy between the size of the fetus and the pelvis

Diagnostically established borderline narrow pelvis

Transverse and oblique position of the fetus

Placenta previa

Vasa previa - presentation of the vessels of the umbilical cord of the fetus, i.e. on the way of a nascent fetus

Premature placental abruption

Umbilical cord prolapse

Threat of uterine rupture due to a large number of pregnancies

Hydramnion

A large number of pregnancies and postoperative scars on the uterine wall, including after a cesarean section

Preeclampsic toxemia

Severe cardiovascular disease

Uterine inertness (oxytocin resistance)

Nephropathy

Premature birth.

Drug interactions

Inhalation of anesthetics may decrease the effect of oxytocin (and also increase the hypotensive effect and the risk of arrhythmia).

Oxytocin-Biolek is not used within 6 hours after vaginal administration of prostaglandins (prostaglandins enhance the uterotonic effect).

The simultaneous use of oxytocin and sympathomimetic vasoconstrictors increases the vasopressor effect.

β-adrenomimetics (sympathomimetics) reduce the effectiveness of oxytocin.

special instructions

Oxytocin-Biolek should be administered intravenously only in the form of drip infusion, precisely observing the infusion rate and regularly monitoring it. During the use of oxytocin, it is necessary to monitor the contractile activity of the uterus, the condition of the fetus, blood pressure and the general condition of the patient.

Particular care should be taken when:

The risk of a mismatch between the size of the fetus and the pelvis (if the risk is significant, the use of oxytocin should be avoided)

Moderate to moderate hypertension due to pregnancy and heart disease

The onset of pregnancy after 35 years

History of cesarean section in the lower segment of the uterus

Intrauterine death of the fetus or with the content of meconium in the amniotic fluid (amniotic fluid embolism may develop).

In the case of water intoxication and hyponatremia, large volumes of fluid should be avoided, and the patient should be limited in fluid intake.

The effect of oxytocin is enhanced with the simultaneous use of prostaglandins (very careful monitoring is required), as well as due to epidural anesthesia (the hypertensive effect of sympathomimetic vasopressors may increase).

If long-term use of oxytocin is necessary, the volume of the infusion solution should be reduced and solutions containing electrolytes rather than glucose should be used (risk of water intoxication, see Side effect). If electrolyte imbalance is suspected, serum electrolyte levels are determined.

Gross formula

C 43 H 66 N 12 O 12 S 2

Pharmacological group of the substance Oxytocin

Nosological classification (ICD-10)

CAS code

50-56-6

Characteristics of the substance Oxytocin

A synthetic analogue of oxytocin - the hormone of the posterior lobe of the pituitary gland. White powder, soluble in water.

Pharmacology

pharmachologic effect- stimulating labor, uterotonizing, lactotropic.

It has the ability to selectively increase the tone and contractile activity of the smooth muscles of the uterus, especially towards the end of pregnancy, during labor and directly during delivery. Acts on specific receptors in the myometrium and increases the intracellular Ca 2+ content. Stimulates rhythmic contractions of the uterus - intensifies and increases their frequency. Acts on the myoepithelial elements of the mammary gland, causes a contraction of the smooth muscles of the walls of the alveoli and stimulates the flow of milk into the large ducts or sinuses, facilitates its release. Possesses pressor properties and can cause an antidiuretic effect when used in large doses. T 1/2 from plasma - about 1-6 minutes (decreases in late pregnancy and during lactation). After intravenous administration of oxytocin, the reaction of the uterus manifests itself almost immediately, and then gradually decreases within 1 hour, after intramuscular injection - after 3-7 minutes and lasts 30 minutes - 3 hours.It is well and quickly absorbed into the systemic circulation through the nasal mucosa ... T 1/2 - less than 10 minutes, excreted mainly by the kidneys (only a small amount unchanged) and the liver. It is actively secreted by the lactating mammary glands. The effect is very individual and depends on the density of oxytocin receptors in the myometrium.

Application of the substance Oxytocin

For the excitement and stimulation of labor (primary and secondary weakness of labor, the need for early delivery due to gestosis, Rh-conflict, intrauterine fetal death; post-term pregnancy, premature discharge of amniotic fluid). For the prevention and treatment of hypotonic uterine bleeding after abortion (including with long periods of pregnancy), in the early postpartum period and to accelerate the postpartum involution of the uterus; to enhance the contractility of the uterus during cesarean section (after removal of the placenta). Hypolactation in the postpartum period. Painful premenstrual syndrome, accompanied by edema, weight gain.

Contraindications

Hypersensitivity, narrow pelvis (anatomical and clinical), transverse and oblique position of the fetus, facial presentation of the fetus, premature birth, threatened uterine rupture, conditions with a predisposition to uterine rupture (including traumatic childbirth and cesarean section in history), excessive stretching of the uterus, uterus after multiple births, partial placenta previa, uterine sepsis, invasive cervical carcinoma, uterine hypertonicity (not occurring during childbirth), fetal compression, arterial hypertension, chronic renal failure.

Application during pregnancy and lactation

Side effects of the substance Oxytocin

Nausea, vomiting, arrhythmia (including in the fetus), bradycardia (in the mother and fetus), increased blood pressure and subarachnoid bleeding or lowering blood pressure and shock, water retention (with prolonged intravenous administration), allergic reactions, bronchospasm; neonatal jaundice, a decrease in the concentration of fibrinogen in the fetus.

Interaction

Enhances the effect of sympathomimetics (combined with caution). Halothane and Cyclopropane increase the risk of side effects.

Overdose

Symptoms: hyperstimulation of the uterus up to rupture, bleeding after childbirth, uteroplacental hypoperfusion, fetal hypoxia and hypercapnia, water intoxication (convulsions are possible).

Treatment: drug withdrawal, forced diuresis, normalization of electrolyte balance.

Route of administration

V / m, v / v(single injection, drip), into the wall or vaginal part of the cervix; intranasally.

Precautions for the substance Oxytocin

According to indications related to childbirth, it is used only under the supervision of a doctor in a hospital under the control of the contractile activity of the uterus, the state of the fetus, blood pressure and the general condition of the woman.

Interaction with other active ingredients

Trade names

Name	The value of the Vyshkovsky Index ®

Oxytocin is a structurally complex hormone that is formed in the brain and performs functions in the body associated with childbirth and lactation. From the brain with the blood flow, oxytocin enters the target organs - the uterus and mammary glands, exerting its influence on them. Oxytocin has a stimulating effect on the smooth muscles of the uterus, increasing its contractile activity, and also affects lactation, since, firstly, it slightly increases the secretion of prolactin, a hormone responsible for milk production, and secondly, it contributes to the reduction of myoepithelial cells (cells surrounding the alveoli of the mammary gland in which milk is produced). This forces the milk out of the glands and into the ducts. Research recent years showed that oxytocin also has an effect on the psychoemotional sphere of men and women, causing a more benevolent disposition towards other people and increasing trust in strangers, and most importantly, oxytocin is involved in the formation of a mother's attachment to a child immediately after childbirth.

The concentration of oxytocin in the blood does not change in different phases and changes little during pregnancy, remaining at a low level. By the end of pregnancy, the amount of oxytocin increases and becomes maximum at night, and decreases during the day, which is why childbirth most often begins at night. During labor, the concentration of oxytocin rises even more and reaches a maximum by the end of the second and third stages of labor.

When and how is oxytocin used?

Oxytocin is administered only intramuscularly or intravenously, less often subcutaneously, since when taken orally, it is rapidly inactivated by enzymes in gastrointestinal tract... After intravenous administration of oxytocin, the uterokinetic effect, i.e. the action associated with an increase in the contractile activity of the uterus appears after 3-5 minutes and lasts about 3 hours. When oxytocin is administered to pregnant women, insignificant amounts of it reach the fetus, and it does not have any significant effect on the fetus. In a woman's body, oxytocin is rapidly destroyed by the enzyme of the same name - oxytocinase, which is located in the muscle of the uterus, mammary glands and placenta. The activity of oxytocinase during pregnancy increases 10 times, which allows you to regulate the concentration of oxytocin in the muscle of the uterus. It is assumed that the sensitivity of the uterus to oxytocin also depends on the number of specific oxytocin-sensitive receptors of the myometrium, which increases during pregnancy, reaching a maximum at the onset of labor.

Based on the action of synthetic oxytocin, indications for its use have been developed. Most obstetricians are quite rightly of the opinion that oxytocin should be prescribed only with therapeutic purpose, and for the rapid completion of a normally proceeding pregnancy, when drug treatment is not required, and stimulation performed at the request of a pregnant woman is categorically unacceptable. Therefore, the indications for the appointment of oxytocin are currently well defined.

Oxytocin is prescribed, firstly, to initiate (induce) and stimulate labor for medical reasons, i.e. in situations where rapid delivery through the vaginal birth canal is necessary due to the high risk of complications in the mother and fetus. This can happen, for example, with premature rupture of amniotic fluid and the absence of contractions, since in this situation, a long (12 hours or more) anhydrous interval increases the risk of infection of the uterus and fetal membranes. Rapid delivery is mandatory in severe progressive gestosis of pregnancy (a condition that is more often manifested by the appearance of edema, protein in the urine, increased blood pressure) - with this complication of pregnancy, the condition of both the mother and the fetus suffers. The indication for the administration of oxytocin is also pronounced (while the mother's body produces antibodies that destroy the red blood cells of the fetus). It is pregnancy that is the determining factor in the development of these conditions; they can be effectively treated only after delivery. In these situations, oxytocin is used only if the cervix is ​​already ready for childbirth - softened, shortened, its canal is slightly open. If the cervix is ​​not yet ready, use different methods, aimed at accelerating the ripening of the neck.

Secondly, oxytocin is used to stimulate or re-intensify labor in the event of a weakening or termination of uterine contractile activity, i.e. with weakness of labor. Weakness of labor is a condition in which the intensity, duration and frequency of contractions are insufficient, therefore, the smoothing of the cervix, the opening of the cervical canal and the advancement of the fetus occur at a slower pace. Primary weakness of labor activity develops from the very beginning of labor, and secondary - after a period of long good labor activity. Weakness of labor is diagnosed by the slow dynamics of the opening of the uterine pharynx (less than 1-1.2 cm per hour) and by the lack of fetal advancement through the birth canal when the size of the pelvis of the mother and the fetus matches. Prolonged immobility of the fetus in the pelvic cavity can lead to compression of the mother's soft tissues with the subsequent occurrence of urogenital or genital fistulas in her and to adverse effects on the fetal head up to cerebrovascular accident and cerebral hemorrhage. Timely administration of oxytocin with weakness of labor helps to avoid such complications.

A bit of history
Oxytocin is the first artificially synthesized hormone. In 1953, the American chemist Vincent Du Vigno studied the structure of oxytocin, and a year later he synthesized it in vitro, i.e. in artificial conditions outside a living organism, for which in 1955 he received the Nobel Prize in Chemistry. Currently, only synthetic oxytocin is used, and previously, oxytocin obtained from animals was used.

In the postpartum period, oxytocin is prescribed mainly to contract the uterus in order to prevent postpartum (hypotonic) uterine bleeding. For the same purpose, during a cesarean section, the drug is injected into the muscle of the uterus.

In addition, after childbirth, oxytocin is used for the prevention and treatment of lactostasis, since it facilitates the initial evacuation of milk from the mammary glands in the early postpartum period, provided that milk formation occurs normally.

Caution Needed!

But for whatever indications oxytocin is prescribed, its use is permissible only with adequate medical supervision, and the use of oxytocin as an initiator or stimulant of labor can be carried out only in a hospital. In this case, oxytocin is administered in such a way that the rate of cervical opening does not differ from those observed during normal childbirth, since both for the mother and the fetus, excessive stimulation of uterine contractions is extremely dangerous.

When prescribing oxytocin, contraindications to rhodostimulation are always taken into account. Oxytocin is contraindicated:

• with a discrepancy between the sizes of the pelvis and the fetal head, as well as with an incorrect position of the fetus, when delivery through the natural birth canal is impossible - for example, with a large fetus, with (pathology of the fetal brain), with the transverse position of the fetus, with a narrow pelvis, frontal presentation - when the head of the fetus is located in such a way that it cannot pass through the birth canal; when the umbilical cord is present (when the umbilical cord is near the exit from the cervix) or when it prolapses, since in this case, birth through the natural birth canal can lead to the death of the fetus, as well as when, because this situation threatens the development of bleeding and is an indication for a cesarean section;
• with a threatening rupture of the uterus, tk. At the same time, birth stimulation can contribute to the rupture of the uterus, which is dangerous for the life of the mother and for the life of the fetus;
• in the presence of scars on the uterus, including scars after cesarean section and myomectomy (surgery to remove nodes of a benign uterine tumor -), because inconsistency of the scars is possible, and therefore the threat of rupture of the uterus;
• in the presence of obstacles to delivery through the vaginal birth canal, for example, with a tumor of the cervix, atresia (infection of the cervix) and its cicatricial changes that prevent the opening of the cervix;
• in the presence of data on increased sensitivity to oxytocin in this patient (there is evidence of oxytocin hyperstimulation of the uterus in previous labor);
• with an immature cervix.

With extreme caution, they decide on the appointment of oxytocin for multiple pregnancy and uterine fibroids.

Oxytocin is used with extreme caution even if the fetus has signs of hypoxia - insufficient oxygen supply, since when oxytocin is used, contractions become more frequent and longer, and during contractions, the blood supply to the placenta significantly deteriorates.

To prevent complications from the use of oxytocin, the dosage of the drug and the mode of administration are strictly observed. The dose of oxytocin administered depends on the indication for its appointment. A large dose is usually required to initiate labor, and a smaller dose to intensify labor. The rate of administration of the drug is gradually increased from a few drops to tens of drops per minute until vigorous labor is established. With the development of sufficient labor, the rate of administration of the oxytocin solution is reduced to the minimum maintenance dose. Preference is given to methods of administration using perfusion pumps, the so-called infusion pumps - special devices that allow you to accurately dose drugs and maintain a constant set rate of drug administration.

During the entire period of administration of oxytocin to control labor and the state of the fetus, obstetricians determine the strength of uterine contractions and the frequency of fetal heart contractions. For this, as a rule, continuous monitoring is carried out using CTG (cardiotocography). The cardiotocograph simultaneously records on paper the frequency and amplitude of contractions and how they affect the fetal heart rate. When the condition of the fetus deteriorates, which is diagnosed by a change in its heartbeat, and in the absence of conditions for rapid delivery through the vaginal birth canal, as well as if the delivery is ineffective, a cesarean section is performed.

Marina Ershova
Obstetrician-gynecologist, Moscow

If someone reads this.

After giving birth, my wife has a dilated uterus, a week has passed and the doctor (in the female consl) wrote us to inject oxytocin intramyrx 2 times.

We will get rid of it, it can somehow affect the child, since he is drinking milk from the breast of the mother.

08/27/2008 01:55:01 AM, vladimir

Oxytocin, prostaglandins and antiprogestogens are drugs that obstetricians use to artificially induce labor and stimulate contractions, to "ripen" the cervix, all of these drugs primarily cause a violation of the uteroplacental circulation, which reduces blood flow through the umbilical cord to the baby, and these drugs they act like this all the time they are in the woman's body. Moreover, the doses administered to each woman in labor act individually, that is, the strength of the action of these drugs cannot be foreseen in advance. And the child strains all his strength to compensate for the decrease in the supply of oxygen with his mother's blood, since the flow of maternal blood is reduced because of the "drugs" administered by the obstetricians (oxytocin, etc.) Now imagine that the child does not have enough strength to fight and the child's self-regulation of blood circulation will be impaired. The brain immediately begins to suffer - its cells do not live long without oxygen. What do obstetricians think, when they say to women in labor, your child suffers, he has hypoxia and therefore we immediately inject oxytocin (or prostaglandin) in order to save the child from hypoxia. "Pretty salvation" after which the born child will necessarily have disturbances in the development of the central nervous system. Lucky - ADHD, cerebral palsy, episodic syndrome, autism syndrome, blindness, deafness, and so on. Who will stop the artificial intervention of obstetricians in childbirth with oxytocin and other "drugs" that are really dangerous for the health of newborn babies, the preservation and normal development of their brain?

08.02.2008 18:05:45, doktor

and the doctor does not know that with severe gestosis and including high pressure, oxytocin cannot be used?

12/20/2007 22:41:28, ekaterina

It would be nice if all the indications for use were vouched, otherwise the neonatologist from the hospital says "oxytocin flows like a river, to the questions of women in labor, what they are injected, the answer is riboxin, and there is oxytocin, as if the goal is to empty the uterus, and what about the baby ... "

"causing a more sympathetic disposition towards other people and increasing trust in strangers" -100 points! :))))