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Oxytocin Pharmacology
During the first stage of spontaneous labor, maternal circulating concentrations of
endogenous oxytocin are approximately that of a continuous infusion of exogenous oxytocin
at 2 to 4 milliunits/minute. During labor, the fetus is thought to secrete about 3
milliunits/minute of oxytocin. Thus, the maternal plus fetal contribution of maternal plasma
oxytocin concentration is equivalent to a range of 5 to 7 milliunits/minute.
The biologic life of oxytocin is 10 to 12 minutes. The uterine response to oxytocin usually
occurs within 3 to 5 minutes of IV administration. There is an inverse relationship between
the duration and dosage of oxytocin and the number of oxytocin receptor sites available for
oxytocin uptake throughout labor. Continued increases in oxytocin rates over a prolonged
period of time can result in oxytocin receptor desensitization (down regulation). This makes
oxytocin less effective in producing normal uterine contractions resulting in the opposite of
the intended effect. Abnormal uterine activity such as persistent coupling or tripling of
contractions, or uterine tachysystole may be the end result of continued increases in oxytocin
rates.
Normal Contraction Pattern
90% of pregnant women at term will have labor successfully induced with 6 milliunits/
minute or less of oxytocin.
Adequate uterine activity has been identified as contractions that occur approximately every
2 to 4.5 minutes and measure 24 to 75 mm Hg in intensity. Resting tone of the uterus
between contractions should be 15 to 20 mm Hg with the uterus being soft when palpated. (It
is important to assure that resting tone is calibrated.) The duration of contractions should be
approximately 60 to 90 seconds in length.
Oxytocin Titration
At least a 30 minute interval is recommended between oxytocin dosage increases (HCA
recommendation) because the full effect of oxytocin on the uterine response to increase
dosage cannot be evaluated until steady-state concentration has been achieved. Increasing
the infusion rate before steady-state concentrations are achieved results in laboring women
receiving higher than necessary dosages of oxytocin. Higher doses and shorter dose intervals
lead to more uterine tachysystole and abnormal FHR patterns, and do not result in a clinically
significant decrease in length of labor.
Once active labor is established in women undergoing induction, oxytocin may often be
discontinued, and may avoid receptor down regulation. This is especially true in cases of
active labor after rupture of membranes.
significantly associated with a higher incidence of fetal academia at birth when compared with
less frequent contractions.
When the FHR is abnormal, the oxytocin should be decreased or discontinued. It makes little
sense to give oxygen for fetal indications and at the same time continue the oxytocin infusion
unchanged.
Communicate patients status both verbally and in writing to appropriate members of the
healthcare team.
Written and verbal communication includes: Baseline, Variability, Accelerations,
Decelerations, Episodic or periodic baseline changes, Trends
*Recent research data by the Hospital Corporation of America (HCA) has now established the
use of the oxytocin administration checklists as the standard of care for their large hospital
system. Non-compliance clearly showed increased adverse fetal outcomes.
Source: Oxytocin Strategies for Improving Maternal and Neonatal Outcomes,
HealthStream online perinatal courses