Usual Adult Dose for Labor Augmentation

Initial dose: 0.5 to 1 milliunits/minute via IV infusion

• Gradually increase dose in increments of 1 to 2 milliunits at 30 to 60 minute intervals until the desired contraction pattern has been established
• Once desired frequency of contractions has been reached and labor has progressed to 5 to 6 cm dilation, the dose may be reduced by similar increments

Comments:

• Dose is determined by uterine response and therefore must be individualized.
• Standard solution for infusion contains 10 milliunits of oxytocin/mL; initial dose of 0.5 to 1 milliunits per minute equals 3 to 6 mL of standard solution per hour.
• For induction or stimulation of labor, IV infusion is the only acceptable method of administration; an infusion pump and frequent monitoring of strength of contractions and fetal heart rate are necessary for safe administration.
• If uterine contractions become too powerful, the infusion should be stopped and oxytocic stimulation of the uterine musculature will soon wane.
• Infusion rates up to 6 milliunits/minute have been shown to produce oxytocin levels found in spontaneous labor; at term, rates exceeding 9 to 10 milliunits/minute are rarely required; before term, higher infusion rates may be needed when the sensitivity of the uterus is lower.

Uses: For the induction or stimulation of labor when medically necessary such as Rh problems, maternal diabetes, preeclampsia at or near term when delivery is in the best interests of mother and fetus, or when membranes have prematurely ruptured and delivery is indicated; for stimulation or reinforcement of labor, as in selected cases of uterine inertia.

Usual Adult Dose for Labor Induction

Initial dose: 0.5 to 1 milliunits/minute via IV infusion

• Gradually increase dose in increments of 1 to 2 milliunits at 30 to 60 minute intervals until the desired contraction pattern has been established
• Once desired frequency of contractions has been reached and labor has progressed to 5 to 6 cm dilation, the dose may be reduced by similar increments

Comments:

• Dose is determined by uterine response and therefore must be individualized.
• Standard solution for infusion contains 10 milliunits of oxytocin/mL; initial dose of 0.5 to 1 milliunits per minute equals 3 to 6 mL of standard solution per hour.
• For induction or stimulation of labor, IV infusion is the only acceptable method of administration; an infusion pump and frequent monitoring of strength of contractions and fetal heart rate are necessary for safe administration.
• If uterine contractions become too powerful, the infusion should be stopped and oxytocic stimulation of the uterine musculature will soon wane.
• Infusion rates up to 6 milliunits/minute have been shown to produce oxytocin levels found in spontaneous labor; at term, rates exceeding 9 to 10 milliunits/minute are rarely required; before term, higher infusion rates may be needed when the sensitivity of the uterus is lower.

Uses: For the induction or stimulation of labor when medically necessary such as Rh problems, maternal diabetes, preeclampsia at or near term when delivery is in the best interests of mother and fetus, or when membranes have prematurely ruptured and delivery is indicated; for stimulation or reinforcement of labor, as in selected cases of uterine inertia.

Usual Adult Dose for Postpartum Bleeding

IM Administration: 10 units IM after delivery of placenta

For patients that have an IV Infusion:

• Add 10 to 40 units to running infusion (depending on amount of electrolyte or dextrose solution remaining)
• Adjust infusion rate to sustain uterine contraction and control uterine atony

Maximum concentration: 40 units to 1000 mL

IM Administration: 10 units IM after delivery of placenta

Comments:

• Dose is determined by uterine response and therefore should be individualized.

Use: For control of postpartum uterine bleeding.

Usual Adult Dose for Abortion

Following suction or sharp curettage for an incomplete, inevitable, or elective abortion: 10 units in 500 mL IV infusion; adjust rate to assist uterus in contraction

Following intra-amniotic injection for midtrimester elective abortion: 10 to 20 milliunits/minute via IV infusion may shorten the injection-to-abortion time
Maximum dose: 30 units in a 12 hour period due to the risk of water intoxication

Comments:

• Dose is determined by uterine response and therefore should be individualized; dosage information is based upon various regimens that have been used.

Uses: Treatment of incomplete, inevitable, or elective abortion.

Renal Dose Adjustments

Use caution

Liver Dose Adjustments

Use caution

Precautions

US BOXED WARNING:

• Elective induction of labor is defined as the initiation of labor in a pregnant individual who has no medical indications for induction. Since the available data are inadequate to evaluate the benefits-to-risks considerations, this drug is not indicated for elective induction of labor.

CONTRAINDICATIONS:

• Hypersensitivity to the active substance
• Significant cephalopelvic disproportion
• Unfavorable fetal positions or presentations, such as transverse lies, which are undeliverable without conversion prior to delivery
• Obstetrical emergencies where the benefit-to-risk ratio for either the fetus or the mother favors surgical intervention
• Fetal distress where delivery is not imminent
• Prolonged use in uterine inertia or severe toxemia
• Hyperactive or hypertonic uterus
• In cases where vaginal delivery is contraindicated, such as invasive cervical carcinoma, active herpes genitalis, total placenta previa, vasa previa, and cord presentation or prolapse of the cord

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:
For Induction of Labor or Augmentation of Uterine Activity:

• IV infusion via an infusion pump to ensure accurate control of the infusion rate

Control of Postpartum Uterine Bleeding:

• IV infusion or IM injection after delivery of the placenta

Treatment of Incomplete, Inevitable, or elective Abortion:

• IV infusion

Storage requirements:

• Store between 20C and 25C (68F to 77F); do not freeze

Reconstitution/preparation techniques:

• 1000 milliunits is equivalent to 1 unit
• Standard solution for infusion of oxytocin for induction/augmentation of labor is 10 milliunits of oxytocin/mL; this can be prepared by adding 10 units of oxytocin to 1000 mL infusion bag of 0.9% sodium chloride or Ringer's lactate
• Maximum concentration recommended to control postpartum uterine bleeding is 40 units/1000 mL
• Available in prepared infusion bags with 0.9% normal saline, dextrose, or lactated ringers

General:

• For induction of labor or augmentation of uterine activity, this drug should be administered by IV infusion with adequate medical supervision in a hospital setting.

Monitoring:

• Uterine activity and fetal heart rate monitoring should be performed throughout the infusion; attention should be given to tonus, amplitude, and frequency of contractions, and to the fetal heart rate in relation to uterine contractions