evitable abortion. in the first trimester, curettage is generally considered primary therapy. in second trimester abortion, oxytocin infusion will often be successful in emptying the uterus. other means of therapy, however, may be required in such cases. postpartum: pitocin is indicated to produce uterine contractions during the third stage of labor and to control postpartum bleeding or hemorrhage.

ersensitive to oxytocin. this fact must be considered by the physician in exercising his judgment regarding patient selection. except in unusual circumstances, oxytocin should not be administered in the following conditions: fetal distress, hydramnios, partial placenta previa, prematurity, borderline cephalopelvic disproportion, and any condition in which there is a predisposition for uterine rupture, such as previous major surgery on the cervix or uterus including cesarean section, overdistention of the uterus, grand multiparity, or past history of uterine sepsis or of traumatic delivery. because of the variability of the combinations of factors which may be present in the conditions listed above, the definition of "unusual circumstances" must be left to the judgment of the physician. the decision can be made only by carefully weighing the potential benefits which oxytocin can provide in a given case against rare but definite potential for the drug to produce hypertonicity or tetanic spasm. maternal deaths due to hypertensive episodes, subarachnoid hemorrhage, rupture of the uterus, and fetal deaths due to various causes have been reported associated with the use of parenteral oxytocic drugs for induction of labor or for augmentation in the first and second stages of labor. oxytocin has been shown to have an intrinsic antidiuretic effect, acting to increase water reabsorption from the glomerular filtrate. consideration should, therefore, be given to the possibility of water intoxication, particularly when oxytocin is administered continuously by infusion and the patient is receiving fluids by mouth. when oxytocin is used for induction or reinforcement of already existent labor, patients should be carefully selected. pelvic adequacy must be considered and maternal and fetal conditions evaluated before use of the drug.

dding 1 ml (containing 10 units of oxytocin) to 1000 ml of 0.9% aqueous sodium chloride or ringer's lactate. the combined solution containing 10 milliunits (mu) of oxytocin/ml is rotated in the infusion bottle for thorough mixing. establish the infusion with a separate bottle of physiologic electrolyte solution not containing pitocin. attach (piggyback) the pitocin-containing bottle with the infusion pump to the infusion line as close to the infusion site as possible. administration the initial dose should be 0.5–1 mu/min (equal to 3–6 ml of the dilute oxytocin solution per hour). at 30–60 minute intervals the dose should be gradually increased in increments of 1–2 mu/min until the desired contraction pattern has been established. once the desired frequency of contractions has been reached and labor has progressed to 5–6 cm dilation, the dose may be reduced by similar increments. studies of the concentrations of oxytocin in the maternal plasma during pitocin infusion have shown that infusion rates up to 6 mu/min give the same oxytocin levels that are found in spontaneous labor. at term, higher infusion rates should be given with great care, and rates exceeding 9–10 mu/min are rarely required. before term, when the sensitivity of the uterus is lower because of a lower concentration of oxytocin receptors, a higher infusion rate may be required. monitoring electronically monitor the uterine activity and the fetal heart rate throughout the infusion of pitocin. attention should be given to tonus, amplitude and frequency of contractions, and to the fetal heart rate in relation to uterine contractions. if uterine contractions become too powerful, the infusion can be abruptly stopped, and oxytocic stimulation of the uterine musculature will soon wane (see precautions section). discontinue the infusion of pitocin immediately in the event of uterine hyperactivity and/or fetal distress. administer oxygen to the mother, who preferably should be put in a lateral position. the condition of mother and fetus should immediately be evaluated by the responsible physician and appropriate steps taken. b. control of postpartum uterine bleeding intravenous infusion (drip method). if the patient has an intravenous infusion running, 10 to 40 units of oxytocin may be added to the bottle, depending on the amount of electrolyte or dextrose solution remaining (maximum 40 units to 1000 ml). adjust the infusion rate to sustain uterine contraction and control uterine atony. intramuscular administration. 1 ml (10 units) of pitocin can be given after the delivery of the placenta. c. treatment of incomplete, inevitable, or elective abortion intravenous infusion of 10 units of pitocin added to 500 ml of a physiologic saline solution or 5% dextrose-in-water solution may help the uterus contract after a suction or sharp curettage for an incomplete, inevitable, or elective abortion. subsequent to intra-amniotic injection of hypertonic saline, prostaglandins, urea, etc., for midtrimester elective abortion, the injection-to-abortion time may be shortened by infusion of pitocin at the rate of 10 to 20 milliunits (20 to 40 drops) per minute. the total dose should not exceed 30 units in a 12-hour period due to the risk of water intoxication. directions for dispensing pharmacy bulk package – not for direct infusion: the pharmacy bulk package is for use in a pharmacy admixture service only in a suitable work area, such as a laminar flow hood. the closure should be penetrated only once utilizing an appropriate sterile transfer device, which allows measured distribution of the contents. the transfer device should be inserted into the pharmacy bulk package using aseptic technique. contents should be used as soon as possible following initial closure puncture. discard any unused portion within 24 hours of first entry. following closure puncture, container should be maintained under labeled storage conditions between 20° to 25°c (68° to 77°f) under a laminar flow hood until contents are dispensed.

arrhythmias neonatal jaundice permanent cns or brain damage neonatal retinal hemorrhage fetal death neonatal seizures have been reported with the use of pitocin. for medical advice about adverse reactions contact your medical professional. to report suspected adverse reactions, contact par pharmaceutical at 1-800-828-9393 or fda at 1-800-fda-1088 (1-800-332-1088) or www.fda.gov/medwatch.

cellular fluid. small amounts of the drug probably reach the fetal circulation. oxytocin has a plasma half-life of about 1 to 6 minutes which is decreased in late pregnancy and during lactation. following intravenous administration of oxytocin, uterine response occurs almost immediately and subsides within 1 hour. following intramuscular injection of the drug, uterine response occurs within 3 to 5 minutes and persists for 2 to 3 hours. its rapid removal from plasma is accomplished largely by the kidney and the liver. only small amounts are excreted in urine unchanged.