Oxytocin, 5 me/ml 1 ml 10 pcs

A synthetic hormonal agent with pharmacological and clinical properties similar to the endogenous oxytocin of the posterior pituitary lobe. It interacts with oxytocin-specific receptors of uterine myometrium belonging to G-protein superfamily. The number of receptors and response to oxytocin increases as pregnancy progresses and reaches a maximum by the end of pregnancy.

Stimulates uterine labor activity by increasing the permeability of cell membranes for calcium and increasing its intracellular concentration, as well as by subsequently decreasing the resting potential of the membrane and increasing its excitability. Causes contractions similar to normal spontaneous labor by temporarily worsening the blood supply to the uterus. With an increase in the amplitude and duration of muscle contractions, the uterine cervix dilates and flattens. In appropriate quantities it is able to increase the contractility of the uterus from a moderate in strength and frequency, typical of spontaneous motor activity, to the level of prolonged tetanic contractions.

Causes contraction of myoepithelial cells adjacent to the alveoli of the mammary gland, improving breast milk secretion.

Acting on vascular smooth muscle, it causes vasodilation and increases blood flow in the kidneys, coronary vessels and brain vessels. Normally, blood pressure (BP) remains unchanged, but when large doses or concentrated oxytocin solution are injected intravenously, BP may decrease temporarily with the development of reflex tachycardia and a reflex increase in cardiac output. The initial decrease in BP is followed by a prolonged, even if small, increase.

Unlike vasopressin, oxytocin has minimal antidiuretic effect, but hyperhydration is possible when administering oxytocin with large amounts of electrolyte solutions and/or when administering them too quickly. It does not cause contraction of the bladder and intestinal muscles.

Indications

Oxytocin is intended for labor induction and stimulation of labor activity.

Parturition in late and near-term pregnancies, when early delivery is necessary due to gestosis, Rh conflict, early or premature rupture of fetal membranes and amniotic fluid discharge, as well as in case of a carried pregnancy (over 42 weeks), intrauterine fetal delay of development, fetal death in utero.

– stimulation of labor activity in primary or secondary weakness of labor activity in the first and second periods of labor.

Oxytocin is also used for the prevention and treatment of hypotonic bleeding after labor and abortion, for caesarean section (after delivery and separation of the placenta), to accelerate postpartum involution and as additional therapy for incomplete or failed (inevitable) abortion.

Active ingredient

Composition

Associates:

Ical acetic acid,

chlorobutanol hemihydrate,

Ethanol 96%,

water d/i.

How to take, the dosage

I/v or i/m.

In order to stimulate and intensify labor, oxytocin is used exclusively in an IV, under hospital conditions with the appropriate medical equipment. Simultaneous use of the drug v/v and v/m is contraindicated. The dose is selected taking into account the individual sensitivity of the mother and fetus.

For labor induction and stimulation of labor activity, oxytocin is used exclusively in the form of an IV drop infusion. Strict control of the prescribed infusion rate is mandatory. The safe use of oxytocin during stimulation and intensification of labor activity requires the use of an infusion pump or similar device, as well as monitoring of uterine contractions and fetal heart rate. In case of excessive intensification of uterine contractile activity the infusion should be stopped immediately, as a result of excessive uterine muscle activity decreases rapidly.

1. A saline solution that does not contain oxytocin should be started before the drug is administered.

2 To prepare a standard oxytocin infusion, dissolve 1 ml (5 IU) of oxytocin in 1000 ml of non-hydrating fluid and mix thoroughly by rotating the bottle. The 1 ml of infusion prepared in this way contains 5 mU of oxytocin. An infusion pump or similar device should be used for precise dosing of the infusion solution.

3. The rate of administration of the initial dose should not exceed 0.5-4 mED/min, which corresponds to 2-16 drops/min, since 1 drop of the infusion contains 0.25 mED of oxytocin). Every 20-40 min, it can be increased by 1-2 mED/min until the desired degree of uterine contractility is achieved. Once the desired rate of uterine contractions corresponding to spontaneous labor has been achieved and the uterine cervix has opened to 4-6 cm and there are no signs of fetal distress, the infusion rate can be gradually reduced at a rate similar to its acceleration.

In late gestation, infusion at a higher rate requires caution; only rarely may a rate greater than 8-9 mEU/min be required. In the case of preterm labor, a higher rate may be required, which in isolated cases may exceed 20 mED/min (80 drops/min).

1. The fetal heartbeat, resting uterine tone, frequency, duration, and force of uterine contractions should be monitored.

2 If uterine hyperactivity or fetal distress occurs, oxytocin infusion should be stopped immediately and oxygen therapy should be provided to the laboring mother. The condition of the laboring mother and fetus should be monitored again by a specialist.

The prevention and treatment of hypotonic bleeding in the postpartum period:

1. IV drip infusion: dissolve 10-40 IU of oxytocin in 1000 ml of non-hydrating fluid; 20-40 mU/min of oxytocin is usually needed to prevent uterine atony.

2. I/m injection: 5 IU/ml oxytocin after separation of the placenta.

Incomplete or failed abortion:

10 IU/ml oxytocin added to 500 ml of saline or a mixture of 5% glucose and saline. The IV infusion rate is 20-40 drops/minute.

Interaction

In administration of oxytocin 3-4 hours after the use of vasoconstrictors in conjunction with caudal anesthesia, severe arterial hypertension is possible.

In anesthesia with cyclopropane, halothane, a change in the cardiovascular action of oxytocin with unforeseen development of arterial hypotension, sinus bradycardia and rhythm from the atrioventricular node in the laboring woman during anesthesia is possible.

Special Instructions

Before using oxytocin, the anticipated benefits of therapy must be weighed against the possibility, albeit small, of hypertension and uterine tetany.

Oxytocin should not be used to induce labor until the fetal head is inserted into the pelvic inlet.

Each patient receiving IV oxytocin must be kept in the hospital under constant supervision by experienced specialists experienced in using the drug and recognizing complications. Immediate assistance from a specialist should be provided if necessary. To avoid complications during the use of the drug, uterine contractions, cardiac activity of the laboring woman and fetus, BP of the laboring woman should be constantly monitored. If there are signs of uterine hyperactivity, oxytocin infusion should be stopped immediately, as a result of which uterine contractions induced by the drug usually subside shortly.

When used appropriately, oxytocin causes uterine contractions similar to spontaneous labor. Overstimulation of the uterus by improper use of the drug is dangerous for both the laboring woman and the fetus. Even with adequate use of the drug and appropriate monitoring, hypertonic uterine contractions occur when the uterus is hypersensitive to oxytocin.

The risk of afibrinogenemia and increased blood loss should be considered.

Partum deaths due to hypersensitivity reactions, subarachnoid hemorrhage, uterine rupture and fetal death due to various causes are known to occur with parenteral administration of the drug for induction of labor and labor stimulation in the first and second periods of labor.

As a result of the antidiuretic effect of oxytocin, hyperhydration may develop, especially when continuous oxytocin infusion and fluid intake are used.

The drug can be diluted in sodium lactate, sodium chlorate and glucose solutions. Ready solution should be used within the first 8 hours after its preparation. Compatibility studies were performed with 500 ml infusions.

The effect of the drug on the ability to drive and operate machinery with increased risk of injury

Oxytocin does not affect the ability to drive and operate machinery with increased risk of injury.

Contraindications

– presence of contraindications for vaginal delivery (e.g. umbilical cord presentation or prolapse, complete or partial placenta presentation, narrow pelvis (mismatch between the size of the fetal head and the birth pelvis), transverse or oblique fetal position preventing spontaneous delivery, urgent, requiring surgical intervention situations due to a maternal or fetal condition, conditions of fetal distress long before the terminal period of pregnancy, prolonged use with inert uterus, severe gestosis (high blood pressure, impaired kidney function), uterine hypertonicity (not occurring during labor), sepsis, heart disease, arterial hypertension, impaired kidney function, fetal face presentation excessive uterine distension, fetal compression).

– hypersensitivity to oxytocin.

Side effects

In women in labor

Reproductive system: at high doses or hypersensitivity – uterine hypertension, spasm, tetany, uterine rupture; increased bleeding in the postpartum period due to oxytocin-induced thrombocytopenia, afibrinogenemia and hypoprotrombinemia, sometimes bleeding into the small pelvis. With careful medical monitoring of labor, the risk of bleeding in the postpartum period is reduced.

Cardiovascular system: at high doses – arrhythmia, ventricular extrasystole, severe hypertension (if vasopressor drugs are used), hypotension (if concomitantly used with the anesthetic cyclopropane), reflex tachycardia, shock, if injected too quickly – bradycardia, subarachnoid hemorrhage.

Digestive system disorders: nausea, vomiting.

Water-electrolyte metabolism: severe hyperhydration with prolonged IV infusion (usually at a rate of 40-50 mED/min) with large amounts of fluid (antidiuretic effect of oxytocin), with 24-hour slow infusion of oxytocin hyperhydration may be accompanied by seizures and coma; rarely – lethal outcome.

The immune system: anaphylaxis and other allergic reactions, if administered too quickly, bronchospasm; rarely – lethal outcome.

In the fetus or newborn

As a consequence of maternal oxytocin administration – low Apgar score on the 1st and 5th minute, hyperbilirubinemia in newborns, if administered too quickly – decrease in blood fibrinogen levels, hemorrhage in the retina; as a consequence of uterine contractile activity – sinus bradycardia, tachycardia, ventricular extrasystole and other arrhythmias, CNS changes, fetal death due to asphyxia.

Overdose

Symptoms mainly depend on the degree of uterine hyperactivity, regardless of the presence of hypersensitivity to the drug. Hyperstimulation with hypertonic and tetanic contractions or with basal tone ≥15-20 mm a.c. between two contractions leads to discoordination of labor, rupture of the body or cervix, vagina, bleeding in the postpartum period, uteroplacental failure, fetal bradycardia, hypoxia, hypercapnia, compression, birth injuries or death. Hyperhydration with seizures as a result of the antidiuretic effect of oxytocin is a serious complication and develops with prolonged administration of large doses (40-50 ml/min).

The treatment of hyperhydration: withdrawal of oxytocin, restriction of fluid intake, use of diuretics to force diuresis, intravenous administration of hypertonic saline solution, correction of electrolyte imbalance, seizure management with appropriate doses of barbiturates and providing careful care for the comatose patient.

Similarities