Pitocin before placenta?

[ceecel.dee, MSN, RN]

Our docs have always ordered Pitocin to be ready for IM injection immediately after the delivery of the placenta.

This afternoon I was called in to help with a delivery, and the med student asked for IM Pit after baby delivery, but before placenta delivery. The regular doc (who has never ordered it that way) said he had read something about that recommendation, and that's what we did.

How are you guys doing it?

[HazeK]

Several of our docs from Canada, have 5 to 10 units of pitocin given IVP,

after the delivery of the baby, before the placenta. Their rationale is the pitocin speed uterine involution, speeding the release of the placenta.

Have not had a problem w/ retained placentas w/ these MDs!

Haze

[OBNurseShelley]

I have been a few places where 5-10u were ordered IVP before placenta but after baby.....I think it worked well......

My question is: do you routinely give it only IM?

I've only used IM if the pt did NOT have IV access.

[SmilingBluEyes]

WHY? The placenta will either spontaneously deliver or not...

throwing tons of exogenous hormone won't make the situation better.

we always use pitocin AFTER the placenta delivers, never before.

[ceecel.dee, MSN, RN]

Yes, many of ours order it IM. IV access is not routine in our hospital, unless there a documented reason for it. Mom's like this policy.

[renerian, BSN, RN]

I would much rather have an IV than IM LOL. JMHO.

renerian

[SmilingBluEyes]

We have done IM pit for people w/o IV access or precip deliveries. BUT IT IS AFTER THE PLACENTA IS OUT, never before.

[moonchild20002000]

We use Pitocin IM or IVP but not before the placenta is delivered.

[finallyRN]

We always give it AFTER the delivery of the placenta.

[fergus51]

We give it before (I am Canadian). Generally it is given IM after the delivery of the shoulders. We give it IV if the woman already has access, but a lot of our moms don't have IVs in place. I have never had any problems administering it this way.

[imenid37]

I took a course called ALSO last year sponsored by the American Academy of Family Practice. It deals w/ a variety of OB situations and what to do scenarios. The whole course is evidence based. They too reccomend starting the pitocin IV (in this case wide open iv 20u/1000 cc bag) after the delivery of the anterior shoulder. I'll find my manual and try to find the sources they cite in that section. Incidentally, this was a great course for nurses to take. In my hospital, where we only have OB/GYN's delivering currently, we open the pit wide after the placenta delivers or give 10 mg IM if no IV. We don't do IV push pit ever. I think that wherever you practice, there's a lot of always/never rules and situations you may not find are written in stone somewhere else.

[SmilingBluEyes]

interesting....

learn something new everyday