Pitocin before placenta?

ceecel.dee, MSN, RN · Sep 10, 2003

Originally posted by imenid37
I took a course called ALSO last year sponsored by the American Academy of Family Practice.

Yes! This MS attended an ALSO course too! That's where she got the info.

She said it (IM or IV Pit post-delivery, but pre-placenta) assisted in, or had something to do with enhancing the delivery of the placenta.

We had always given it after delivery, only if bleeding was unusually heavy. I guess I have to wonder why the need to enhance or assist in placental delivery before you even know if there would have been a problem at all? And how do you know if the mom would have been a bleeder if the placenta has not even detached yet? Maybe I'm just not into intervention if intervention need has not even been determined. Perhaps too conservative.:imbar

SmilingBluEyes · Sep 10, 2003

I think like you do, ceecee....

the fewer interventions, the better if there is no problem, why fix it? i would love to learn the rationale for this however.

like i said, we learn something new everyday.

fergus51 · Sep 11, 2003

I consider this a prophylaxis, just like erythro in the eyes and vit k shots. I think the rationale is there really isn't much risk in giving it as oposed to not.

Dayray, RN · Sep 11, 2003

I've never heard of giving pit before delivery of the placenta that is interesting. I guess it couldent hurt I never really belived that the cervix would sudenly slam shut after starting pit.

What surprised me was seeing how many people said they are being told to give pit IVP rather then diluted in IV fluid. IV push pit causes immediate hypotention. There are many studies out on this and it has in some cases caused death.

L&D_RN_OH · Sep 11, 2003

We use IM pit prn if no IV access. Otherwise we use 10-20 units Pit in LR after delivery of placenta.

ceecel.dee, MSN, RN · Sep 11, 2003

Okay, during a LONG pushing phase today, I asked the doc from the other day what the rationale was, being we are never given a chance to even see if the woman would be a heavy bleeder. He said that research has shown (via the ALSO literature) that ALL women benefit, with higher postpartum hemaglobins across the board.

That has to be good!

BETSRN · Sep 12, 2003

First, we only give pitocin AFTER the delivery of the placenta and that is only if there is any piticin running in the first place. My point is that if pitocin is NOT necessary or not being used, then it is not necessary to use it after unless there is an indicaqtion to do so.

We NEVER give the pitocin IM at all.

bbnurse · Sep 12, 2003

We use pitocin in the IV fluid rather than straight IVP, and bolus for about 500cc. The PDR and ACOG does not recommend straight IVP of pitocin. And it is after the placenta.

imenid37 · Sep 12, 2003

Here' the reference from last year's ALSO manual:

Section J Postpartum Urgencies Slide 6 Oxytocin w/ shoulder delivery (I have a a note from the lecture 70% reduction in pph)

Section J p.2 "Active Management of the third stage is reccomended by the Cochrane reviewers * (category A- That is there is good evidence to support the reccomendation). This combines oxytocin given at the time of delivery of the anterior shoulder with early cord clamping and cutting and controlled cord traction. (Our instructors emphasized not YANKING on the cord). These manuevers have been shown to reduce postpartum hemmorhage by two thirds, yet not increase the need for manual placental removal or endanger undiagnosed second twins."

Again, if you have the opportunity to take this course, DO IT! It is very, very good.

* Mcdonald S, Prendaville WJ, Elbourne D Active vs. expectant management in the third stage of labour (Cochrane Review). In: The Cochrane Library, Issue 2, 2000. Oxford: Update Software.

ceecel.dee, MSN, RN · Sep 16, 2003

Okay...here's the latest.

Another delivery with same doc (he's been very busy lately), we gave IV Pit (we were inducing her anyway, so just opened it up after baby delivered). They (doc and MS) broke the cord, mom ended up in the OR for manual placental extraction. Hgb 9.4 ppd 1.

I'm not convinced quite yet that this is great, but perhaps I'm slow.

fergus51 · Sep 16, 2003

Even the best practices aren't 100% successful.

sbic56, BSN, RN · Sep 16, 2003

9.4 is a pretty good hgb after having a retained placenta. Hard to know if the pit increased the risk of the retained placenta or if that was going to happen anyway and the pit actually helped decrease the blood loss. This is an interesting new intervention. I haven't seen it used, but bet I will.