Oxytocin: Induction, Augmentation, and Postpartum Hemorrhage

Oxytocin, marketed as Pitocin, is the most commonly used uterotonic agent in obstetrics. It is a synthetic form of the naturally occurring hypothalamic hormone that stimulates uterine contractions during labor and milk letdown during breastfeeding. Because of its narrow therapeutic index and the serious harm that can follow misuse, oxytocin appears on the Institute for Safe Medication Practices high-alert medication list for the obstetric setting, which means extra safeguards are expected during its administration. Oxytocin has several clinical uses. It is used to induce labor when cervical conditions are favorable, to augment labor when contractions are inefficient during active labor, to prevent postpartum hemorrhage through routine administration after delivery of the placenta, and to treat postpartum hemorrhage at higher doses when uterine atony occurs. Each use carries its own dosing and safety considerations. The central nursing responsibility during an oxytocin infusion is to titrate the dose carefully to achieve an adequate contraction pattern, generally three to five contractions in ten minutes, each lasting 40 to 60 seconds with complete uterine relaxation between them, while preventing tachysystole and fetal compromise. The...