Pitocin ante/post partum administration

[Woman_in_love]

Hi everyone!

I have few questions about Pitocin administration for Ante/Post partum patients.

1)At what rate do you administer Pitocin infusion for laboring and post partum patients?Any significant differences here?

2)What are most common side effects of Pitocin you've seen on your patient?

3)Is that true that the more deliveries/pregnancies woman had, the slower infusion of Pitocin should be in post partum and why? Why is it more dangerous in multigravidas?

Thanks

[SmilingBluEyes]

Pitocin is titrated in the antepartum phase, for labor augmentation and induction. The goal is to gain moderate-strong uterine contractions, sufficient enough to cause the cervix to dilate...ROUGHLY 1 centimeter an hour (but I try not to get all hung up on Friedman curves myself).

So, the answer to your question is this: you raise or lower the rate (in milliunits) based on the adequacy of labor, the wellbeing of the fetus and mother and regularity and strength of contractions. Individual hospital policies do vary. Ours states, after reassuring fetal monitor strip x20 minutes, and assessment/assurance of vertex presentation and dilatation/effacement of cervix, we begin at 1 milliunit/minute and go up by 1-2 milliunits/min each 15-30 minutes, to a maxiumum of 20 millunits/minute. Some places go up to 30/min but this requires a special dr order where I am. Also, must have continual FHM, vital sign assessment q30 min on mom during pitocin inductions.

After delivery, pitocin is almost like another drug. We can run it in much more rapidly, if need be, to ensure contraction of the uterus and prevention of bleeding after delivery. I usually try only to do this if the uterus is boggy and/or mom is not breastfeeding afterward. Otherwise, I massage the uterus and encourage BF asap and run the pitocin at roughly 125ml/hr, until infused. Be aware: Pitocin acts like anti-diuretic hormone in that it DOES tend to cause fluid retention and can lead to toxicity if over-used and fluids are not watched judiciously.

Also, long-term pitocin use in labor can lead to the uterus not responding after delivery and bogginess or lack of tonus. These are some things all L/D nurses are aware of and watch for.

HTH

[SmilingBluEyes]

PS:

there are no set "rules" as to whom pitocin is more dangerous for, multigravidas versus primips......again, you base your rates on your continual assessments of mom and baby and labor progress. The above precautions and rules apply in all laboring moms where I work.

[klone, MSN, RN]

Antepartum, we titrate by 2 mu, every 20 minutes, until a good labor pattern is reached, not to exceed 36.

Postpartum, we put 10-20 in the bag and run it on bolus rate. Some OBs like 5 IVP and 5 in the bag.

I've never heard that pit used postpartum is more dangerous in multips. In fact, multips are going to be the ones more likely to need pit postpartum.

[jcutler]

When would you stop the pitocin? Would it be if contractions are over 90 seconds or if the frequency is less than every 2-5 mins? What are the toxicity signs?

[NurseNora, BSN, RN]

We start at 1mU/min and increase 1-2mU/min q30min until adequate contraction pattern. The top dose a nurse is able to give is 20mU/min. The doc can increase it more if he/she wishes.

If there are more than 5 contractions in a 10 min period (averaged over 30 min), the pit is turned off or decreased because it can potentially cause problems with fetal oxygenation.

The only reason I can think of to run Pit more slowly in a multip is that after pains are more painful the more babies you've had. The uterus contracting after the birth of a first baby is usually painless. It tends to become more painful with subsequent pregnancies. I tell my patients that it's because their uterus is now older and more used that it was the first time and it has to work harder to get back to the nonpregnant state that it did the first time.

I've never seen Pitocin toxicity in over 40 years. I've seen overstimulation of the uterus during an induction. I've seen patients retain fluid after being on pit for a long time, but I've never seen anyone retain enough to develop pulmonary edema (knock wood). If pit is run in something like D5W, that would be more likely, but it's run in some sort of crystaloid fluid to keep that from happening. In the old days, we used to give 10U IV push at delivery and I've seen patients become hypotensive afterwards, that's why we don't give it IV push anymore.

Remember that pitocin is just a synthetic version of oxytocin which is naturally produced by the pituitary gland. There are 3 things that cause large amounts of oxytocin to be released by the pituitary. Labor, let down reflex during breast feeding, and female orgasim. Remember Pitocin is our friend!