Question about pitocin after delivery

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I was taught to run the pitocin (20units/1000ccLR) after the placenta delivers with the theory being that you don't want it to run in before the placenta delivers because you don't want the cervix to clamp down and make the placenta unable to pass through it...we have one MFM attending who has us do it before the placenta delivers...she said the latest research shows that it doesn't effect the placenta's ability to deliver. She is the only one I've delivered with that doesn't want me wait for the placenta to run the pit. What is standard practice for your hospital? Not every patient at our hospital gets pitocin after delivery (people without IVs who have bleeding WNL, some CNM patients etc.) but most do.

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It doesn't affect the ability of the placenta to be delivered. In many places in Canada it is standard procedure to give pitocin when the anterior shoulder of the baby is delivered as research has shown it to be beneficial in decreasing blood loss.

http://www.mdbrowse.com/Druginf/O/oxytocin.htm

According to this is, it's one way it can be recommended for use

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From ALSO manual:

Section J Postpartum Urgencies Slide 6 Oxytocin w/ shoulder delivery

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. 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."

* 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.

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Specializes in OB.

We give Pitocin 20u in 1000 cc after the placenta is out, I usually start at 1200cc/hr and then decrease by half (600cc/hr) after two or three fundal checks with little bleeding and then again by half and keep it running until the entire 1000cc's is in and then, int the IV.

If the Pt has no IV (CNM pt, or no time for IV) we give 10u pitocin IM after delivery of the placenta.

Hope this info helps

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Specializes in L & D; Postpartum.

I'm trying to figure this out. 1200cc/hr would run a liter in in 50 minutes; then you run another 600cc/hr for 3 checks. Our checks are q 15 so that liter would be long gone before ever switching to the 600cc/hr. Maybe I'm misunderstanding but if you start with full liters, in two hours time, you'd have run in 1800 cc of fluid. That seems like a lot to me. Especially if your patient has an epidural, no foley and won't be able to get up to urinate any time soon. If your checks are more frequent than q 15, then maybe it's not a problem. Help me here.

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Fergus, thanks for that info. I'm going to take it in to our ob docs.

We give 10 units Pit IM after delivery of the placenta because most of our deliveries are low risk and we have no IV access. If there is an IV started for some reason (epidural or pain meds) we give 10 units into the nearest port to the IV site after delivery of the placenta.

If there has been pp bleeding, the Pit will go into the IV mainline fluid bag - usually 10 units too.

steph

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No problem Steph, I think it was posted in another thread too by another poster. We always gave 10 units IM with the delivery of the anterior shoulder in Canada. I was kind of surprised they didn't in the US. (It's like the use of nitrous oxide).

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That's interesting Fergus..I'll have to share the info with our NM and docs. Our low risk patients with no IV access (CNM pts with no epidural, kept po fluids down during labor, GBS neg) who are having number first or second delivery don't get any pit, just funal massage, unless they have heavier bleeding, then they get 10u IM. Otherwise we always mainline 20u/1000cc--titrate along with fundal massage, expression to keep uterus firm. They have pit for 4-6 hours after delivery (8 hours for C/S). The heavy bleeders get double strength (40u/1000cc) for their first bag then regular until 6 hours. The really heavy bleeders get the whole 9 yards (, double strength pit, miso, hemabate, methergine etc.)

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We gave it to everyone and usually didn't need it in the IV Laura. Our docs and midwives felt the preventative value made it worthwhile even for low risk patients. I liked it and it made me a little nervous when I went to work in the US. Change is always a little disconcerting:)

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We add 20 Units of Pitocin to the IVF's after the delivery of the placenta and run it in wide open.

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We add 20 Units of Pitocin to the IVF's after the delivery of the placenta and run it in wide open.

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Specializes in OB, lactation.

I have a related question... does giving the pit give the woman more cramps than she would have had without? Does it make breastfeeding cramps worse than in the women without the extra pit at the end? Just curious.

I don't remember if I got it w/ my first two babies (probably, I had epidurals), with the last one I had the pit after delivery but it infiltrated and the nurse just said "oh you're doing fine" and let it go.

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