Uses
Elective induction of labor (i.e., no medical indication for induction) merely for clinician or patient convenience is not a valid indication for oxytocin use.
IV infusion of dilute solutions is the method of choice for inducing labor at term and stimulating uterine contractions during the first and second stages of labor.
Labor Induction
Use for labor induction is indicated in term or near-term pregnancies associated with hypertension (e.g., preeclampsia, eclampsia, cardiovascular-renal disease), erythroblastosis fetalis, maternal or gestational diabetes mellitus, antepartum bleeding, premature placenta rupture (abruptio placentae) chorioamnionitis, or premature rupture of the membranes in which spontaneous labor does not ensue.
Routine induction of labor with oxytocin may be indicated in prolonged pregnancies (greater than 42 weeks’ gestation).
Eclampsia: if delivery is not imminent within 12 hours following an initial oxytocin infusion, consider cesarean section rather than continued oxytocin administration.
Induction of labor also may be indicated in cases of uterine fetal death (demise), fetal compromise (e.g., fetal growth retardation, isoimmunization), or static or decreasing maternal weight. However, may be relatively ineffective in cases of missed abortion, intrauterine fetal death in late pregnancy, benign hydatidiform mole, or fetuses with anencephaly or erythroblastosis fetalis with hydrops or other congenital abnormalities incompatible with life; some clinicians recommend intravaginal dinoprostone.
Induction of labor also may be indicated because of maternal medical conditions (e.g., diabetes mellitus, renal failure, COPD, chronic hypertension).
Carefully evaluate pelvic adequacy and other maternal and fetal conditions (including fetal lung maturity) whenever labor induction is considered.
If labor induction is indicated and cervical status is unfavorable, an agent for cervical ripening (e.g., dinoprostone) may be administered initially.
Do not use to induce labor when the benefit-to-risk ratio for the mother or child favors surgical intervention.
Labor induction and/or oxytocin may be contraindicated in certain fetal and/or maternal conditions. (See Contraindications)
Augmentation of Labor
May use during the first and second stages of labor to augment contractions if labor is prolonged or if dysfunctional uterine inertia (oxytocin usually not to exceed 6–8 hours) occurs.
Not recommended when labor is progressing normally during the first and second stages or when hypertonic patterns of labor occur, especially since drug response may be accentuated during the second stage of labor.
Do not use to augment labor when vaginal delivery is contraindicated (e.g., total placenta previa).
Postpartum Abbreviation of Third Stage of Labor
Has been used to shorten the third stage of labor immediately following delivery of the infant (when the absence of additional fetuses is established); oxytocin usually is recommended if an oxytocic is used for this purpose.
Oxytocics may inhibit rather than assist in placenta expulsion, and increase the risk of hemorrhage and infection.
Postpartum Control of Uterine Bleeding
Routinely used postpartum or following cesarean section to stimulate immediate uterine contractions and control uterine bleeding.
Postpartum hemorrhage and uterine atony: Ergonovine or methylergonovine usually preferred (due to more sustained contractions and higher uterine tonus) unless an immediate contractile response is desired.
IV oxytocin followed by an IM amine ergot alkaloid may be preferred.
Termination of Pregnancy
Has been used to shorten the induction-to-abortion time following prostaglandin or hypertonic abortifacients for induction of second trimester abortions; to induce abortion after failure to respond to the abortifacient; or to induce abortion after membrane rupture.
Has been used as an adjunct in incomplete abortion (when placenta fails to abort spontaneously within 1 hour after fetal abortion), but may hinder rather than assist in placental expulsion.
Usually, do not administer until the abortifacient oxytocic effect has subsided, and carefully monitor; concurrent use of oxytocin with abortifacients may produce intense uterine contractions that increase risk of uterine rupture or cervical laceration.
Evaluation of Fetal Respiratory Capability
Successfully used to evaluate the adequacy of fetal respiratory capabilities in high-risk pregnancies of >31 weeks gestation.†
Transiently impedes uterine blood flow by inducing uterine contractions.†
Positive response (late deceleration in fetal heart rate indicating chronic hypoxia) may occur if placental reserve is low.†
Positive response may be fetal distress and may be indication for pregnancy termination, especially if a lecithin-sphingomyelin ratio >1.5 can be demonstrated.†
Negative response (fetal heart rate unchanged) indicates adequate placental support is probably available.†
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