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Medicinal reference book geotar. Oxytocin: uses and contraindications

Oxytocin is a drug that has a stimulating effect on smooth muscles uterus. Under its influence, the tone and contractile activity of the myometrium and the concentration of calcium in the cells increase. The drug causes contraction of myoepithelial cells that are adjacent to the alveoli of the mammary glands, thereby promoting lactation.

As a result of the effects of Oxytocin on smooth muscle vascular walls clearance increases blood vessels and blood flow in the vessels of the brain, coronary vessels and kidneys. In addition, with the use of Oxytocin, a slightly pronounced antidiuretic effect is observed.

In this article we will look at why doctors prescribe the drug Oxytocin, including instructions for use, analogues and prices for this drug in pharmacies. If you have already used Oxytocin, leave your feedback in the comments.

Composition and release form

Solution for injection (1 ml in ampoules, 10 ampoules in contour plastic packages, 1 package in a cardboard pack);
Solution for injection and topical use (1 ml in glass ampoules: 10 ampoules in contour plastic packages, 1 or 2 packages in a cardboard pack; 5 ampoules in contour plastic packages, 2 packages in a cardboard pack);
Solution for intravenous and intramuscular administration (1 ml in ampoules: 5 or 10 ampoules in cardboard packs; 5 ampoules in contour plastic packages, 1 or 2 packages in a cardboard pack; 10 ampoules in strip packaging, 1 package in a pack cardboard).

Clinical and pharmacological group: a drug that increases the tone and contractile activity of the myometrium.

What is Oxytocin used for?

There are several main indications for which a specialist prescribes the use of a synthetic hormone to his patients. Let's take a closer look at what exactly the drug is used for:

To stimulate primary and secondary weakness labor activity;
To induce early labor due to fetal death;
For the prevention and treatment of uterine bleeding;
To increase uterine contractions during caesarean section;
To eliminate the pain of premenstrual syndrome.

The effect of oxytocin is not indicated for all patients; when prescribing the drug, a specialist must take into account contraindications. If for some reason the patient was not warned about this, then all the main contraindications can be easily found in the accompanying instructions, which are inside absolutely every box.

Oxytocin - what is it?

Oxytocin is synthetic hormonal agent, which interacts with oxytocin-specific receptors in the muscular layer of the uterus. In the later stages of pregnancy, the body's response to the action of Oxytocin increases significantly and reaches a maximum towards the end of pregnancy.

According to the instructions, oxytocin stimulates labor by increasing the permeability of cell membranes to calcium, as well as increasing its amount inside the cells, which provokes an increase in the excitability of the membrane.

The action of Oxytocin for a short period of time impairs the blood supply to the uterus, which causes contractions that are similar to normal spontaneous labor. In addition, the use of Oxytocin stimulates the production of breast milk and leads to a reduction in myoepithelial cells in the alveoli of the mammary glands.

Instructions for use

It is usually preferable intramuscular injection drug. If intramuscular administration does not produce results or an immediate effect is needed, then intravenous administration of oxytocin is resorted to, which should be administered slowly.

Oxytocin is prescribed intramuscularly or intravenously at a dose of 1-3 IU. During caesarean section, a dose of 5 IU is injected into the muscles of the uterus. For gynecological indications, it is prescribed subcutaneously or intramuscularly at a dose of 5-10 IU.

Before administering oxytocin, the syringe, if stored in alcohol, must be rinsed in distilled water.

Contraindications

Hypersensitivity, fetal distress, partial placenta previa, preterm birth, discrepancy between the size of the fetal head and the pelvis of the mother, conditions with a predisposition to uterine rupture, excessive distension of the uterus, the uterus after multiple births, cases of uterine sepsis, invasive carcinoma of the cervix, increased blood pressure, renal failure.

Side effects

It is necessary to understand that the drug can cause a whole series side effects both in mothers during abortion and in the fetus. The impact is carried out at the level of several systems at once. Such problems arise extremely rarely, but if they do occur, then every effort must be made promptly to ensure that they are eliminated.

Let's consider the negative effects in a woman in labor that correspond to the use of the drug:

From the heart and blood vessels: if the drug is administered too quickly, subarachnoid hemorrhage and bradycardia may occur. Also, rapid administration of the drug can lead to the patient having a fever. blood pressure or, on the contrary, it will decrease, and reflex tachycardia will begin.
Reproductive system: tetany, spasm, uterine hypertension, uterine rupture.
Digestive system: dyspepsia.
Immune system: allergies, anaphylaxis.
Water-electrolyte metabolism: with prolonged intravenous administration Severe overhydration is possible, sometimes accompanied by convulsions and coma.

A fetus or newborn from oxytocin may experience symptoms of jaundice and may experience retinal hemorrhage. In particular in rare cases tachycardia may begin, sinus bradycardia, arrhythmia, brain and central damage nervous system. To prevent this from happening, everything must be very well monitored by a doctor, who can quickly take action at the first changes.

Pregnancy and lactation

In the first trimester of pregnancy, oxytocin is used only for spontaneous or induced abortions. Numerous data on the use of oxytocin, its chemical structure And pharmacological properties indicate that if the recommendations are followed, the likelihood of oxytocin influencing an increase in the incidence of fetal malformations is small.

IN small quantities excreted in breast milk. When using the drug to stop uterine bleeding Breastfeeding can be started only after completing the course of treatment with oxytocin.

Special instructions

Carry out treatment with Oxytocin only under the supervision of a doctor in a hospital setting under the control of contractile activity of the uterus, the condition of the fetus, blood pressure and general condition women.

Analogs

Oxytocin-Vial, Oxytocin-Verein, Oxytocin-Grindeks, Oxytocin-Richter, Oxytocin-MEZ, Pitocin, Syntocinon.

Attention: the use of analogues must be agreed with the attending physician.

Prices

The average price of OXYTOCIN in pharmacies (Moscow) is 60 rubles.

Terms and conditions of storage

Keep away from children. Store in a place protected from light at a temperature of 2 to 15 °C. Shelf life – 3 years.

Oxytocin injection solution(Solutio Oxytocin pro injectionibus)

International name: oxytocin;

Basic physical and chemical characteristics : transparent colorless liquid, with a specific smell;

Compound. 1 ml of solution includes synthetic oxytocin - 5 IU;

other ingredients: chlorobutanol hydrate, water for injection.

Release form of the medicinal product. Solution for injection

Pharmacotherapeutic group. Hormones of the posterior lobe of the pituitary gland. ATS code N01B B02.

Action of the medicine. Synthetic oxytocin has it all biological properties, which is a natural hormone. The drug produces strong contractions of the uterine muscles, especially in pregnant women, which is due to the effect on the membranes of myometrial cells. Under the influence of the drug, the permeability of membranes for potassium ions increases, their potential decreases and excitability increases. Synthetic oxytocin stimulates milk secretion, enhances the production of the lactogenic hormone of the anterior pituitary gland - prolactin. In addition, the drug promotes rapid elimination milk from the mammary gland due to the effect on its contractile elements. The drug has a weak antidiuretic effect and does not significantly affect blood pressure. A change in the secretion of this hormone leads to pathological course childbirth and disruption of the mammary gland during lactation.

Pharmacokinetics. The plasma half-life is 3–5 minutes. This hormone is inactivated by the enzyme oxytocinase, which is found in the blood of pregnant women (the enzyme disappears from the body 10–14 days after birth), as well as by specific enzymes that are found in the kidneys, uterus, and retroplacental blood plasma. Due to the absence of proteins in the drug, intravenous administration is safe regarding the possibility of anaphylactic shock and pyrogenic effect.

Indications for use. Oxytocin is used to stimulate labor or its weakness (with premature departure peripartum fluid). Also prescribed for the prevention and treatment of hypotonic uterine bleeding in the early postpartum period (including increased uterine involution), for artificial stimulation labor during pregnancy complications, increased contractility of the uterus during caesarean section, increased lactation. Incomplete or septic abortion, gynecological bleeding (after diagnosis).

Method of use and dose. Oxytocin is administered intravenously, intramuscularly, and

also into the cervix or uterine wall. To induce labor, 0.5–2.0 IU of Oxytocin is injected intramuscularly and, if necessary, injections are repeated every 30–60 minutes. In case of weak labor activity, long-term (during all births) intravenous drip administration of Oxytocin at a dose of 5 IU is recommended. Before use, 1 ml (5 IU) of the drug is diluted in 500 ml of 5% glucose solution. Administration begins with 5–8 drops per 1 minute with the next increase in speed (every 5–10 minutes by 5 drops, but not more than 40 drops per 1 minute) until vigorous labor is established. After its establishment, the amount of solution administered can be reduced to the minimum maintenance level. Simultaneous intravenous administration of the drug in a dose of 0.2 ml (1 IU) in 20 ml of 40% glucose solution is allowed only with full dilation of the cervix and the presence of conditions for rapid natural delivery. To stimulate contractions, 0.25 - 1.0 IU of Oxytocin is usually administered intramuscularly. To prevent hypotonic uterine bleeding, the drug is administered intramuscularly at 3-5 IU 2-3 times a day daily for 2-3 days; for bleeding, administer 5–8 IU 2–3 times a day for 3 days. Depending on the clinical situation, it can also be administered intravenously or into the cervix. If necessary, both for prevention and treatment, administration of the drug can be repeated after a 5-day break. During caesarean section (after extraction of the fetus), in order to prevent bleeding, Oxytocin is administered intravenously or into the muscles of the uterus in a dose of 3–5 IU. To enhance lactation, Oxytocin is administered intramuscularly at 1–2.5 IU 30–40 minutes before feeding for 3–5 days.

Side effect. When using Oxytocin, nausea, vomiting, extrasystole, and fetal cardiac arrhythmia are possible. It is also possible allergic reactions in the form of bronchospasm (in patients with bronchial asthma).

Contraindications. The use of Oxytocin to induce labor is contraindicated in cases of discrepancy between the size of the mother's pelvis and the fetal head, transverse and oblique positions of the fetus, the presence of scars on the uterus after a previous cesarean section or other operations on the uterus, suspected premature placental abruption, intrauterine fetal hypoxia, and placenta previa. , with a threatening uterine rupture, narrow pelvis.

Overdose. Manifested by symptoms of uterine hyperstimulation: tetanic contractions of the uterine muscles, preeclampsia, urinary retention, increased blood pressure, as well as excessively active labor, which can lead to acute hypoxia fetus, premature detachment of a normally located placenta, uterine rupture. If signs of complications appear, drug administration should be stopped, fluid administration should be reduced, forced diuresis should be used for elimination and symptomatic treatment.

Features of use. Oxytocin is used only under the supervision of a physician, taking into account individual sensitivity to the drug. IN in some cases after the administration of Oxytocin at a dose of 1 IU, sharp contractions may develop, resulting in intrauterine fetal hypoxia; in other cases, the total dose of the drug can be 4–5 IU. Sometimes, for the purpose of inducing labor, Oxytocin is prescribed together with prostaglandins. When administering the drug intravenously during childbirth, from the beginning of drip administration, it is recommended to use antispasmodic and analgesic agents (promedol, aprofen, etc.). Intravenous administration of the drug produces an intensification of contractions (after 0.5 - 1 minute) - weak contractions become stronger, and in the absence of contractions (they usually appear quickly). Intramuscular administration exhibits a less dramatic effect. Oxytocin should be used to control the contractility of the uterus, the condition of the fetus, blood pressure and the general condition of the woman.

Interaction with other drugs. A complex prescription is possible in complex therapy with antispasmodics, analizing agents and prostaglandins. Use cautiously in combination with sympathomimetics.

Storage conditions and periods. Store in a place protected from light at a temperature of 8 °C to 20 °C. Shelf life – 2 years.

The physiological state of a person largely depends on hormonal levels. Oxytocin with an oligopeptide structure is considered one of the important hormones. In men, under its influence, parochial altruism increases, emotional (spiritual) ties in relation to loved ones are strengthened. Women experience suppression of anxiety and a sense of fear, stimulation of uterine contractility, which is important during childbirth to facilitate the passage of the fetus through birth canal.

What oxytocin, the hormone of love and affection, consists of and how it works, what are the known ways to increase it if the concentration is insufficient, we will consider further in the article.

Oxytocin, what kind of drug?

Oxytocin is a substance produced by the hypothalamus in men and women and subsequently transported to the posterior lobe pituitary gland The influence of oxytocin on the psycho-emotional background of people has been proven. Also, based on this hormone, pharmaceutical companies published the drug Oxytocin with the same name. Previously, medicine used a substance obtained from animals. Today the hormone is exclusively synthetic and has been found wide application in gynecology with injection into the uterine muscle.

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

during childbirth in case of weak uterine contractions;
during a caesarean section;
in the postpartum 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 pregnancy termination.

Composition and release form

Oxytocin is available in solutions for injection (i.v., i.m.). On appearance This:

clear sterile liquid;
without any special smell or color.

1 ampoule contains:

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

Properties

Oxytocin is considered a complex hormone in structure, but is very important and is produced by 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, as it is able to increase concentration during hugs, kisses, and touches;
helps people adapt to society, regulates communication;
suppresses drug addiction, cravings for smoking, cocaine, alcohol;
has a calming effect, normalizes sleep;
stimulates the most in a person best qualities: generosity, cordiality, hospitality;
activates the body's defenses and begins to show aggression to the onslaught of irritants.

Oxytocin of protein origin plays an important role for women:

helps regulate behavioral reactions in women during pregnancy;
stimulates the birth process;
has a relaxing effect on smooth muscle blood vessels, 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 other hormone impurities;
has a beneficial effect on the uterus and mammary glands;

normalizes blood pressure;
relaxes vascular muscles;
facilitates the birth process in women, begins to stimulate contractility uterus and the production of breast milk, prevent the development of congestion;
increases the secretion of prolactin, which begins to produce breast milk and accelerate the passage through 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 menstrual cycle in women there is practically no change in blood. Even during pregnancy in the 2-3 trimester, with unstable hormonal levels, it can only increase slightly at night.

Pharmacology and pharmacokinetics

The mechanisms of action of Oxytocin are due to its influence on myometrial cells, leading to an increase in the excitability and permeability of their membranes to potassium ions. This is how stimulation of the uterus begins and the production of lactogenic hormone in women.

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

Absorption of the drug into the bloodstream is rapid. Metabolization of active particles occurs in the liver. The elimination process is carried out by the kidneys.

REFERENCE! Oxytocin is not able to have a pronounced antidiuretic effect and does not affect blood pressure. Practically free from proteins, therefore does not lead to anaphylactic reactions when administered intravenously.

The drug has a powerful abortifacient effect. Can cause miscarriage or contractions in women before childbirth.

Indications for use

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

contractions to stimulate the uterine cavity;
C-section;
atonic bleeding;
delay uterine discharge in the postpartum period;
the need for early delivery due to intrauterine growth retardation;
conflict Rh factor;
gestosis;
intrauterine fetal death;
long pregnancy over 42 weeks;
preventive measures after childbirth or abortion for hypotonic bleeding;
conducting an incomplete (failed) abortion as an additional therapy.

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

developmental defect in the fetus;
frozen pregnancy.

Administration of the drug 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 ovum came out of the uterine cavity. Doctors need to track contractile functions uterus and the general well-being of women, since after the administration of oxytocin there is a high probability of bleeding.

Contraindications

Oxytocin is a drug that should only be used under medical supervision. Self-medication is excluded.

As a rule, the medicine is administered to women to initiate and stimulate labor, but there are contraindications for use as a labor stimulant:

incorrect (transverse, frontal) presentation of the fetus with the inability of the head to exit through the birth canal naturally when doctors resort to caesarean section;
discrepancy between the sizes of the pelvis and head;
detection of hydrocephalus in the case of brain pathology in the fetus;
high probability of bleeding;
threat of uterine rupture, which poses a danger to the life of the fetus and mother;
excessive sensitivity to active substances oxytocin;
narrowness of the pelvis in women in labor;
cervical immaturity;
the appearance of hyperstimulation after administered oxytocin;
premature birth;
umbilical cord prolapse;
severe gestosis;
sepsis or severe distension of the uterus;
heart disease (arterial hypertension);
renal dysfunction.

Note! For the purpose of terminating pregnancy, the administration of oxytocin is contraindicated in women who have 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 artificial termination of pregnancy due to Oxytocin.

In case of an overdose of oxytocin, immediate rehydration measures must be taken:

stop infusions;
limit fluid intake;
adjust water and electrolyte balance;
treat 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, heavy bleeding, 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 when the uterus is overly sensitive to active component.

In particular, unpleasant symptoms be called from outside reproductive system in case:

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

Possible side symptoms:

spasms, uterine rupture;
bleeding;
thrombocytopenia;
hemorrhage in the pelvic organs.

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

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

If Oxytocin is administered slowly and for a long time, a disruption of the water-electrolyte balance may occur, appearing 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 high speed, jaundice and retinal hemorrhage in a newborn may occur.

Note! Incorrect administration can cause asphyxia and fetal death. If the drug is administered to pregnant women at home, then the reason for urgent withdrawal should be: following signs: 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 administer Oxytocin solution intramuscularly. If the detailed version does not lead to the expected results, then you can switch to injection into a vein, but rather slowly.

The average dosage for 1 session is 1-3 IU. For gynecological indications, it can be increased to 10IU. For caesarean section - 5IU.

To terminate a pregnancy, the selection is made by a doctor, taking into account the duration and frequency of uterine contractions. At first, Oxytocin is administered slowly (no more than 16 drops per minute). Then you can gradually increase the speed by 48 drops every 20-40 minutes in order to achieve the desired degree of uterine contractility. As the uterine pharynx dilates to 6 cm, it is recommended to reduce the rate of oxytocin infusion, i.e. start introducing in the reverse order with decreasing drops.

If the drug is administered later pregnancy, then the rate of administration should not be higher than 30 drops per minute. When using Oxytocin in the case of premature labor, the rate should be approximately 75-80 drops per minute. In this case, the tone and duration of uterine contractions and the fetal heartbeat must be kept under complete control.

It is used according to the following scheme:

placing 1 piece behind the cheek without swallowing and leaving until completely absorbed;
taking the 2nd tablet after 30-40 minutes.

The maximum dosage per day is 500 units. If there is no effect from taking it before a medical abortion, then it is allowed to take 1 additional tablet. If the abortion does not seem to have taken place, then to stimulate labor it is worth administering the drug intravenously at a dose of 5 mU

Interaction with other drugs

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

Reference! You cannot administer a solution of intramuscular and intravenous Oxytocin at the same time. When choosing optimal doses for women in labor, it is important to take into account individual tolerance, monitor the strength of uterine bleeding and fetal cardiac activity

Special instructions

Oxytocin is an antidiuretic, so giving infusions or taking tablets orally can cause overhydration.
Oxytocin should not be used if you are allergic to the active ingredients. Otherwise, you should be prepared for bleeding and fainting.
Improper dosing may cause uterine rupture.
You cannot start inducing labor with Oxytocin if the fetal head is just entering the pelvic area.
It is necessary to administer intravenously Oxytocin only in a hospital setting so that doctors can provide timely the right help. It is equally important to keep under control the dynamics of uterine contractions and cardiac activity in the mother (child).

Oxytocin may become indispensable for keeping the condition of the fetus and the birth process under control in women. But it must be administered correctly, observing dosages, 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 come running and take only the right decision about performing a cesarean section when the condition of the fetus changes or labor stimulation with the drug is ineffective.

Oxytocin is a complex hormone that is produced in the brain and performs functions in the body associated with childbirth and lactation. From the brain, through the bloodstream, oxytocin reaches the target organs - the uterus and mammary glands, exerting its effect on them. Oxytocin has a stimulating effect on the smooth muscles of the uterus, increasing its contractile activity, and also has an effect on lactation, since, firstly, it slightly increases the secretion of prolactin, the hormone responsible for milk production, and secondly, it promotes the contraction of myoepithelial cells (cells surrounding the alveoli of the mammary gland, where milk is produced). This causes milk to be “pushed” from the glands into the ducts. Research recent years showed that oxytocin also has an effect on psycho-emotional sphere men and women, causing more favorable attitudes towards other people and increasing trust in strangers, and most importantly, oxytocin is involved in the formation of mother-child attachment immediately after birth.

When and how is oxytocin used?

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

Based on the effect of synthetic oxytocin, indications for its use were 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 normal pregnancy, when drug treatment is not required, and stimulation performed at the request of a pregnant woman is categorically not acceptable. Therefore, the indications for prescribing oxytocin are now quite clearly defined.

Oxytocin is prescribed, firstly, to initiate (induce) and stimulate labor by medical indications, i.e. in situations where rapid vaginal delivery is necessary due to the high risk of complications in the mother and fetus. This can happen, for example, with premature rupture amniotic fluid and the absence of contractions, since in this situation a long (12 hours or more) anhydrous period increases the risk of infection of the uterus and membranes. A quick delivery is mandatory in case of severe progressive gestosis of pregnancy (a condition that is more often manifested by the appearance of edema, protein in the urine, and 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 (in this case, 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, before administering oxytocin, various methods are used to accelerate the ripening of the cervix.

Secondly, oxytocin is used to stimulate or re-intensify labor when the contractile activity of the uterus weakens or stops, i.e. with weakness of labor. Weakness of labor is a condition in which the intensity, duration and frequency of contractions are insufficient, so the effacement of the cervix, the opening of the cervical canal and the advancement of the fetus occur at a slow pace. Primary weakness of labor develops from the very beginning of labor, and secondary weakness develops after a period of prolonged good labor. Weakness of labor is diagnosed by the slow dynamics of opening of the uterine pharynx (less than 1-1.2 cm per hour) and by the absence of advancement of the fetus along the birth canal when the sizes of the pelvis of the mother and fetus correspond. Prolonged immobile standing of the fetus in the pelvic cavity can lead to compression of the mother’s soft tissues with the subsequent occurrence of genitourinary or enterogenital fistulas and adverse effects on the fetal head until violation cerebral circulation and cerebral hemorrhages. Timely administration of oxytocin in case of weakness of labor helps to avoid such complications.

A little history
Oxytocin is the first hormone synthesized artificially. In 1953, the American chemist Vincent Du Vigneault studied the structure of oxytocin, and a year later he synthesized it in vitro, i.e. V artificial conditions outside a living organism, for which in 1955 he received Nobel Prize in chemistry. Currently, only synthetic oxytocin is used, but 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 to prevent and treat lactostasis, as it facilitates the initial evacuation of milk from the mammary glands in the early postpartum period, provided that milk formation occurs normally.

Caution is necessary!

But no matter what 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 only be carried out in a hospital. In this case, oxytocin is administered in such a way that the rate of opening of the cervix does not differ from those observed during normal childbirth, since excessive stimulation of uterine contractions is extremely dangerous for both the mother and the fetus.

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

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

The issue of prescribing oxytocin for multiple pregnancies and uterine fibroids is addressed with extreme caution.

Oxytocin is used with extreme caution even if the fetus has signs of hypoxia - insufficient oxygen supply, since when using oxytocin, 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, strictly adhere to the dosage of the drug and the administration regimen. The dose of oxytocin administered depends on the indications for its use. To initiate labor, a larger dose is usually required, and a smaller dose is required to intensify contractions. The rate of administration of the drug is gradually increased from several drops to tens of drops per minute until vigorous labor is established. When sufficient labor develops, 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, so-called infusion pumps - special devices that allow precise dosing medicines and maintain a constant set rate of drug administration.

During the entire period of oxytocin administration, to monitor labor and the condition of the fetus, obstetricians determine the strength of uterine contractions and the frequency of fetal heart contractions. For this purpose, as a rule, continuous monitoring is carried out using CTG (cardiotocography). The cardiotocograph simultaneously records on paper the frequency, amplitude of contractions and how they affect the fetal heart rate. If the condition of the fetus worsens, which is diagnosed by changes in its heartbeat, and in the absence of conditions for rapid delivery through the vagina, as well as if labor stimulation is ineffective, a caesarean section is performed.

Marina Ershova
Obstetrician-gynecologist, Moscow

If anyone reads this.

My wife has an enlarged uterus after giving birth, a week has already passed and the doctor (in the female consulate) ordered us to inject oxytocin intramuscularly 2 times.

We are afraid that this might somehow affect the child, since he drinks milk from our mother’s breast.

08/27/2008 01:55:01, 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 disruption of the uteroplacental circulation, which reduces the flow of blood through the umbilical cord to the baby, and these drugs They act this way the entire time they are in the woman’s body. Moreover, the administered doses for each woman in labor act individually, that is, the strength of action of these drugs cannot be predicted in advance. And the child strains all his strength to compensate for the decrease in the supply of oxygen with the mother’s blood, since the influx of maternal blood is reduced due to the “medicines” administered by 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 disrupted. The brain will immediately begin to suffer - its cells do not live long without oxygen. What are obstetricians thinking? when they tell your mothers in labor the child is suffering there is hypoxia and therefore we immediately administer oxytocin (or prostaglandin) to save the child from hypoxia. “A good rescue” after which the born child will definitely have disturbances in the development of the central nervous system. Just those who are lucky will “get off” with tone disorders, autonomic dysfunction, and delay speech, but unlucky - ADHD, cerebral palsy, episyndrome, autism syndrome, blindness, deafness, etc. Who will stop the artificial intervention of obstetricians in childbirth with oxytocin and other "medicines" that are really dangerous to the health of newborn children, the preservation and normal development their brain?

02/08/2008 18:05:45, doctor

and the doctor doesn’t know what happens with severe gestosis, including high blood pressure Shouldn't oxytocin be used?

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

It would be good if all the indications for use were covered, otherwise a neonatologist from the maternity hospital says “oxytocin flows like a river, when women in labor ask what they are being given, the answer is Riboxin, and then there is oxytocin, as if the goal is to empty the uterus, and what’s wrong with the child ..."

“generating a more favorable attitude towards other people and increasing trust in strangers” -100 points! :))))

international and chemical name: oxytocin;

synthetic cyclic pentapeptide;

Basic physical and chemical properties

colorless, transparent solution;

Compound

1 ml contains 5 (IU) oxytocin;

excipients: glacial acetic acid, chlorobutanol hemihydrate, ethyl alcohol (96%), water for injection.

Release form

Solution for injection.

Pharmacotherapeutic group

Hormones of the posterior lobe of the pituitary gland.

ATS code Н01В В 02.

Pharmacological properties

Pharmacodynamics. The clinical and pharmacological properties of oxytocin are similar to those of endogenous oxytocin of the posterior pituitary gland. The uterine musculature contains oxytocin-sensitive receptors of the G-protein receptor family. As pregnancy progresses, the number of oxytocin receptors and the sensitivity of the uterus to it grow and reach its maximum by the end of pregnancy.

Oxytocin causes contraction of the smooth cell muscles of the uterus by increasing the concentration of intracellular potassium. With increasing amplitude and duration muscle contractions the uterine os expands and smoothes. Oxytocin causes contractions by temporarily reducing blood flow to the uterus. IN certain quantities Oxytocin is able to enhance the contractility of the uterus to a level characteristic of normal labor, and up to a tetanic state.

Oxytocin causes contraction of myoepithelial cells adjacent to the alveoli mammary gland, and thereby promotes milk secretion.

By acting on the smooth cell muscles of blood vessels, oxytocin causes vasodilation, increases blood flow to the kidneys, coronary vessels heart and brain. In this case, blood pressure usually remains unchanged, but with the intravenous administration of large doses of concentrated oxytocin, blood pressure can temporarily decrease with the development of reflex tachycardia and a reflex increase in cardiac output. After some initial decrease in pressure, a prolonged, albeit small, increase in blood pressure occurs.

Unlike vasopressin, oxytocin has a weak antidiuretic effect. Overhydration is possible with the simultaneous use of oxytocin with large volumes of electrolyte-free liquids and/or with its rapid administration.

When administered intravenously, the effect of oxytocin on the uterus appears almost instantly and lasts for 1 hour. At intramuscular injection The myotonic effect occurs in the first 3-7 minutes and lasts for 2-3 hours.

Pharmacokinetics. Like vasopressin, oxytocin is distributed throughout the extracellular space. Small amounts of oxytocin appear to enter the fetal circulation.

The half-life of oxytocin is 1-6 minutes, it is shorter in the last period of pregnancy and during lactation. Most of the drug is broken down in the liver and kidneys. In the process of enzymatic hydrolysis, oxytocin is inactivated, mainly under the action of tissue oxytocinase (oxytocinase is also found in the placenta and plasma). Only a small amount of oxytocin is excreted unchanged in the urine.

Indications for use

Induction of labor, stimulation of labor during primary and secondary labor weakness, as well as with caution in the first and second stages of labor. Prevention and treatment of placental bleeding and atonic uterine bleeding (in case of cesarean section Oxytocin injected directly into the uterine muscle). Insufficient uterine involution in the postpartum period (to control subinvolution and bleeding). Incomplete or septic abortion. For gynecological bleeding (after establishing a histological diagnosis).

For diagnostics: to determine the respiratory capacity of the feto-placental unit (stress test with oxytocin).

Directions for use and doses

The dose is determined taking into account the individual sensitivity of the pregnant woman and the fetus.

For induction or stimulation of labor Oxytocin is used exclusively as an intravenous drip infusion. Compliance with the prescribed infusion rate is mandatory. For safe use oxytocin requires the use of an infusion pump or other similar device, as well as monitoring of uterine contractions and fetal cardiac activity. In case of excessive increase in contractile activity of the uterus, the infusion should be stopped immediately, as a result of which the excessive muscular activity of the uterus quickly decreases.

1. You should start with an infusion of a solution that does not contain oxytocin.

2. To prepare a standard infusion of oxytocin in 1000 ml of solvent (0.9% ) dissolve 1 ml (5 IU) oxytocin and mix. In 1 ml of infusion prepared in this way, 5 mMO of oxytocin is obtained. For precise dosing of the solution, an infusion pump or other similar device should be used.

3. The rate of administration of the initial dose should not exceed 0.5-4 mmIU/min. Every 20-40 minutes it can be increased by 1-2 mMO until the desired degree of contractile activity of the uterus is achieved. When the degree of uterine contractions corresponding to normal labor is achieved and the uterine os is dilated by 4-6 cm in the absence of signs of fetal distress, the infusion rate can be gradually reduced at a rate similar to its acceleration. In late pregnancy, oxytocin can be administered more rapidly, but care must be taken because infusion rates of 8–9 mmIu/min may only occasionally be required. At premature birth Accelerated administration of oxytocin may be necessary; however, sometimes the speed can exceed 20 mmu/min.

4. It is necessary to monitor the fetal heartbeat, the tone of the uterus at rest, the frequency, duration and strength of its contractions.

In the event of excessive uterine contractions or fetal distress, oxytocin administration should be stopped immediately and oxygen therapy should be provided to the parturient, while the parturient and fetus should be under the supervision of a specialist physician.

To stop uterine bleeding in the postpartum period:

1) Intravenous drip infusion: 1000 ml (0.9% sodium chloride solution, 5% glucose solution) dissolve 10-40 IU of oxytocin to prevent uterine atony, 20-40 mmU/min of oxytocin is necessary.

2) Intramuscular: 1 ml (5 IU) of oxytocin after separation of the placenta.

As adjuvant therapy for incomplete abortion:

10 IU of oxytocin in 500 ml of 0.9% sodium chloride solution or a mixture of 5% dextrose with 0.9% sodium chloride solution. The rate of intravenous infusion is 20-40 drops/min.

To diagnose uteroplacental insufficiency (stress test with oxytocin):

Need to start intravenous infusion at a rate of 0.5 mmU/min and double the speed every 20 minutes until an effective dose is reached, usually 5-6 mmU/min, maximum 20 mmU/min. After the appearance of three moderate contractions lasting 40-60 seconds each within a 10-minute period, you should stop administering oxytocin and monitor the change, i.e., the slowdown in fetal cardiac activity.

During caesarean section, Oxytocin is injected into the uterine muscle at a dose of 5 IU. At gynecological indications- subcutaneously or intramuscularly at a dose of 5-10 IU.

Side effect

For women in labor:From the reproductive system: Large doses or hypersensitivity to the drug can cause hypertension, cramps, tetany and uterine rupture; increased bleeding in the postpartum period due to thrombocytopenia, afibrinogenemia and hypoprothrombinemia. Sometimes a pelvic hematoma is possible. It is possible to reduce the risk of bleeding in the postpartum period by systematically monitoring the progress of labor.

From the outside cardiovascular system : the use of large doses of oxytocin can lead to arrhythmia; premature ventricular contraction; hypertension following hypotension; reflex tachycardia.

From the digestive system: nausea, vomiting.

From the side of water-electrolyte metabolism: due to the antidiuretic action of oxytocin when administered intravenously (usually at 40-50 mmIU/min) simultaneously with a large number fluid, severe overhydration is possible. States of severe overhydration with convulsions and coma can also develop with a slow, more than 24-hour infusion administration oxytocin. There is a known case of hyperhydration with the death of a woman in labor.

From the immune system: anaphylaxis and other allergic reactions, rarely fatal.

In the fetus or newborn: low Apgar scores when determined 5 minutes after birth, neonatal jaundice, retinal hemorrhage in newborns.

Sinus bradycardia, tachycardia, premature ventricular contractions and other arrhythmias, residual damage to the central nervous system and brain, fetal death due to asphyxia, as a result - increased contractile activity of the uterus.

Contraindications

Increased sensitivity to oxytocin; discrepancy between the sizes of the fetus and the pelvis of the woman in labor, narrow pelvis (severe degree of narrowing); unfavorable position of the fetus (oblique and transverse), which prevents spontaneous birth; emergency situations caused by the condition of the mother or fetus requiring surgical intervention; state of fetal distress long before the terminal stages of pregnancy; hypertonicity of the uterus; the presence of contraindications for vaginal delivery (for example, umbilical cord presentation or prolapse, central placenta previa and marginal placenta previa).

In cases of severe toxemia or weak contractile labor activity of the uterus long-term use Oxytocin is contraindicated.

Overdose. Symptoms of overdose depend mainly on the degree of sensitivity of the uterus to oxytocin and are not associated with the presence of hypersensitivity to the active component of the drug. Overstimulation can lead to strong (hypertensive) and prolonged (tetanic) contractions, or rapid birth with a characteristic base tone of 15-20 or more mm aq. Art., measured between two contractions, and can also cause rupture of the body or cervix, vagina, bleeding in the postpartum period, utero-placental hypoperfusion, slow fetal cardiac activity, hypoxia, hypercapnia and fetal death.

Long-term use of the drug in large doses (40-50 ml/min) may be accompanied by a severe side effect - hyperhydration caused by the antidiuretic effect of oxytocin.

Treatment consists of stopping the oxytocin infusion, limiting fluid intake, using diuretics, intravenous hypertonic saline solution, correction of electrolyte balance, relief of seizures with barbiturates and providing professional care for a patient who is in a coma.

Features of application

The use of the drug is contraindicated if there is a history of hypersensitivity to oxytocin.

Except special occasions, the use of oxytocin is not recommended for premature birth; with a significant degree of narrowing of the pelvis; previously undergone surgery on the uterus or cervix, including after caesarean section; excessive increase in uterine tone; multiple pregnancy; invasive stage of cervical carcinoma. Until the fetal head or pelvis enters the pelvic inlet, oxytocin cannot be used to induce labor. Identifying so-called special cases caused by combinations of various factors is the task of the doctor. Before starting the use of oxytocin, the expected beneficial effects of therapy should be carefully weighed against the dangers (although rare, hypertonicity and uterine tetany are possible).

In order to induce labor and enhance uterine contractility, oxytocin is used exclusively intravenously, in a hospital and with appropriate medical supervision. Each patient receiving an oxytocin infusion should be closely monitored by a physician familiar with the drug and its use. side effects. Medical specialist who has passed special training, should be kept nearby in case of side effects.

To avoid complications, you should constantly monitor uterine contractions, the cardiac activity of the mother and fetus, and the mother’s blood pressure. At the first sign of uterine hyperactivity, oxytocin should be stopped immediately; as a result of this uterine contractions symptoms caused by the drug usually subside soon.

At adequate application Oxytocin causes uterine contractions similar to normal birth. Excessive stimulation that occurs when the drug is used incorrectly is dangerous for both the mother and the fetus.

It must be borne in mind that in cases of hypersensitivity to the drug, hypertensive contractions are possible even with adequate use of the drug. The possibility of increased bleeding and the development of afibrinogenemia should be taken into account.

There are known cases of death of a woman in labor as a result of hypersensitivity reactions, subarachnoid hemorrhage, uterine rupture, as well as cases of fetal death due to various reasons during parenteral use of the drug for the purpose of inducing labor and stimulating uterine contractions.

The antidiuretic effect of the drug promotes water retention in the body. The possibility of overhydration should be noted special attention when using a constant infusion of oxytocin and drinking fluids orally.

At parenteral administration the drug can be used either intravenously or intramuscularly only.

Pregnancy and breastfeeding: in the first trimester of pregnancy, oxytocin is used only for spontaneous or induced abortions.

The chemical, pharmacological properties of oxytocin and numerous data on its use indicate that when used as prescribed, the likelihood of its effect on increasing the incidence of fetal malformations is small.

Passes into breast milk in small quantities.

In cases where the drug is used to stop uterine bleeding, breastfeeding can be started only after completing the course of treatment with oxytocin.

Interaction with other drugs

When oxytocin is administered 3-4 hours after the simultaneous use of vasoconstrictors and against the background of caudal anesthesia, severe hypertension is possible.

Anesthesia with cyclopropane may alter the cardiovascular effect of oxytocin - hypotension is possible.

There is a known case when the simultaneous use of oxytocin and cyclopropane caused sinus bradycardia and atrioventricular rhythm in the patient.

Incompatibility The drug can be diluted in 0.9% sodium chloride solution, 5% glucose solution, sodium lactate solutions, Salina. The prepared solution must be used within the first 8 hours after preparation.