PRECAUTIONS
General
1. All patients receiving intravenous oxytocin must be under continuous observation
by trained personnel who have a thorough knowledge of the drug and are
qualified to identify complications. A physician qualified to manage any
complications should be immediately available. Electronic fetal monitoring
provides the best means for early detection of overdosage (see OVERDOSAGE
section). However, it must be borne in mind that only intrauterine pressure
recording can accurately measure the intrauterine pressure during contractions. A
fetal scalp electrode provides a more dependable recording of the fetal heart rate
than any external monitoring system.
2. When properly administered, oxytocin should stimulate uterine contractions
comparable to those seen in normal labor. Overstimulation of the uterus by
improper administration can be hazardous to both mother and fetus. Even with
proper administration and adequate supervision, hypertonic contractions can
occur in patients whose uteri are hypersensitive to oxytocin. This fact must be
considered by the physician in exercising his judgment regarding patient
selection.
3. Except in unusual circumstances, oxytocin should not be administered in the
following conditions: fetal distress, hydramnios, partial placenta previa,
prematurity, borderline cephalopelvic disproportion, and any condition in which
there is a predisposition for uterine rupture, such as previous major surgery on the
cervix or uterus including cesarean section, overdistention of the uterus, grand
multiparity, or past history of uterine sepsis or of traumatic delivery. Because of
the variability of the combinations of factors which may be present in the
conditions listed above, the definition of “unusual circumstances” must be left to
the judgment of the physician. The decision can be made only by carefully
weighing the potential benefits which oxytocin can provide in a given case against
rare but definite potential for the drug to produce hypertonicity or tetanic spasm.
4. Maternal deaths due to hypertensive episodes, subarachnoid hemorrhage, rupture
of the uterus, and fetal deaths due to various causes have been reported associated
with the use of parenteral oxytocic drugs for induction of labor or for
augmentation in the first and second stages of labor.
5. Oxytocin has been shown to have an intrinsic antidiuretic effect, acting to
increase water reabsorption from the glomerular filtrate. Consideration should,
therefore, be given to the possibility of water intoxication, particularly when
oxytocin is administered continuously by infusion and the patient is receiving
fluids by mouth.
6. When oxytocin is used for induction or reinforcement of already existent labor,
patients should be carefully selected. Pelvic adequacy must be considered and
maternal and fetal conditions evaluated before use of the drug.
Drug Interactions
Reference ID: 3638684