LESSON PLAN

ON
OXYTOCICS
NAME THE TEACHER : S.JEEVITHA

SUBJECT : OBSTETRIS AND GYNAECOLOGICALNURSING

TOPIC : OXYTOCICS
TIME : 45 MINUTES

PLACE : III YEAR GNM

METHOD OF TEACHING : LECTURE CUM DISSCUSSION

AV AIDS : BLACK BOARD, PPT

LANGUAGE : ENGLISH

PREVIOUSKNOWLEDGE :THE STUDENTS HAVING LITTLE KNOWLEDGE

ABOUT OXYTOCICS
GENERAL OBJECTIVES:

At the end of the class the students will be able to

understand the oxytocics

SPECIFIC OBJECTIVES:

At the end of the class the students will be able to

 Introduction of oxytocics
 List the type of oxytocics
 Mention the mode of action
 Explain the preparation of oxytocin
 Describe the diagnosis
 Enumerate the management

TIME SPECIFIC CONTENT TEACHERS LEARNERS AV EVALUATI

OBJECTIVS ACTIVITY ACTIVITY AID ON
S
. B
L
5min Introduction of
INTRODUCTION A
oxytocics Oxytocics are the drugs of varying chemical C What is mean
nature that have the power to stimulate the Explainig and Listening and K by oxytocics?
questioning answering. B
contraction of O
uterine muscles. A
• Also called Uterotonics R
• The introduction of oxytocic drugs for the D
treatment of Post Partum Hemorrhage &
(PPH) has been regarded as “one of the P
enduring achievements of modern science”. P
5mins List the type • It is essential for a midwife to have a T
of oxytocics
thorough knowledge of these drugs What are the
OXYTOCICS-CLASSIFICATION type of
Among a large number of drugs belonging oxytocics?
to this group the ones that are important and
extensively used
are :-
B
 Oxytocin
L
A
 Ergot Derivatives
C
Explainig and Listening and K
 Prostaglandins questioning answering. B
OXYTOCIN O
• Oxytocin is an octapeptide synthesized in A
 the hypothalamus and is secreted by the R
posterior pituitary. D
• Oxytocin secretion occurs by sensory &
P
stimulation from cervix,vagina and from P
5mins suckling at breast. T
• The pregnant uterus is sensitive to
Mention the What are the
mode of action
oxytocin in the later months than earlier oxytocin
months of pregnancy. receptors?
• It has a half life of 3-4 minutes and
duration of action of approximately 20
5mins minutes
Explain the OXYTOCIN- MODE OF ACTION
preparation of • Oxytocin binds to oxytocin receptors in the Whats mean
oxytocin myometrial cell membrane. by
B syntocinon?
• Acts directly on myofibrils producing Explainig and Listening and L
uterine contractions & stimulates milk questioning. answering. A
ejection by the breasts C
• As it stimulates physiological uterine K
contractility with fundal dominance and B
O
dilatation of the cervix, it is ideal for A
induction and augmentation of labour. R
OXYTOCIN- PREPARATIONS D
Synthetic oxytocin available for parenteral &
use includes:- P
 Syntocinon: 5units/ml in ampoules of P
1ml(can be used as controlled infusion in T
RL or NS)
Pitocin: 10 units/ml in ampoule of 0.5 ml
Syntometrine: A combination of syntocin 5
units & ergometrine 0.5mg
Oxytocin nasal solution: 40 IU/ml (not
3mins
much in use)
Desamino oxytocin: It is not inactivated by
Explain the oxytocinase enzyme and is 50-100% more Explainig and
oxytocin questioning Listening and
effective than oxytocin. Used as buccal answering.
indication
(oral) B
tablets containing 50 IU. Not much in use. L
OXYTOCIN- INDICATIONS A
Pregnancy: C
K
• To induce abortion
B
• To expedite expulsion of hydatidiform O
mole A
• For oxytocin challenge test R
• To stop bleeding following evacuation. D
OXYTOCIN- INDICATIONS &
Labour P
P
• Induction & augmentation of labour
T
• In uterine inertia
 • To prevent & treat postpartum hemorrhage Explainig and Listening and
2mins questioning answering
• Treatment of atonic PPH
Postpartum
List out the • To initiate milk let-down in breast
sideeffect engorgement
• Promotion of uterine involution
OXYTOCIN-DIAGNOSTIC
INDICATIONS
• Oxytocin challenge test or contraction
stress test To assess if fetus can stand B
L
stress of labour A
• Oxytocin sensitivity test To assess C
responsiveness to Oxytocin K
OXYTOCIN-CONTRAINDICATIONS B
In Pregnancy O
 Grand multipara A
R
 Contracted pelvis or CPD D
 History of LSCS or hysterectomy &
 Malpresentation P
Explainig and Listening and P
OXYTOCIN-CONTRAINDICATIONS questioning answering T
During labour
 All contraindications mentioned in
pregnancy
 Obstructed labour
 Non reassuring fetal status
 Incoordinate uterine action
Anytime
Hypovolemic state, cardiac disease
OXYTOCIN-SIDE EFFECTS B
L
Maternal Risks
A
 Uterine overactivity or hyperstimulation C
 Uterine rupture K
 Hypotension B
 Water retention & intoxication O
A
 Hypertension R
 Ventricular premature beats D
 Myocardial ischemia or ventricular &
fibrillation Explainig and Listening and P
questioning answering P
OXYTOCIN-SIDE EFFECTS
Fetus T
 Fetal distress
 Fetal asphyxia
 Fetal death
 Increased incidence of neonatal jaundice
METHODS OF ADMINISTRATION OF
OXYTOCIN B
Controlled intravenous infusion- L
• Started at low dose rate at 1-2 mIU/ min A
and increased gradually C
K
• Escalated by 1-2 mIU/min at interval of B
20-30 minutes to maximum 8 mIU/min O
• When the optimal response of sustained 3 Explainig and Listening and A
contractions in 10 minutes lasting for about questioning answering R
45 seconds is met, oxytocin will be D
maintained at that concentration. &
OXYTOCIN-DRUG CALCULATION P
P
Drug order- Pitocin 2mu/min T
Availability-10 units in 500 cc
RL500 ml x10 units
1 x 2mu = 1000
1000 1 hr 10000= 0.1
0.1 ml x 60 (to convert to ml/hour as dose
given is 2mu/min)0.1 ml x 60= 6 ml/hour
OXYTOCIN-NURSING
CONSIDERATIONS
• Assess Patient I/O Ratio, Uterine B
contraction, BP, pulse & respiration, rate of L
flow, FHR and progress of labour. A
• Administer by IV infusion after having Explainig and Listening and C
crash cart available in the ward questioning answering K
 • Evaluate patient’s length & duration of B
contractions and notify physician of O
10mins
contractions lasting over one minute or A
Describe the R
ergot absence of contractions. D
derivation • Teach patient and family to report &
increased blood loss, abdominal cramps or P
increased temperature P
ERGOT DERIVATIVES-MODE OF T
ACTION
• Ergometrine acts directly on the
myometrium causing sustained or tetanic
contractions of upper and lower segments of
uterus.
• However it is highly effective in
hemostasis and stops bleeding. Explainig and
• Methylergometrine is slower in producing questioning Listening and
uterine response than ergometrine answering B
ERGOT DERIVATIVES-ROUTE L
Ergometrine & Methergine can be used A
C
parenterally or orally. Syntometrine should K
always be administered IM B
Note: As the drug produces tetanic uterine O
contractions, it should only be used after A
delivery of the anterior shoulder or R
following delivery of baby. D
It should not be used in induction of labor or &
abortion. Explainig and P
questioning Listening and P
ERGOT DERIVATIVES- answering T
PREPARATIONS
• Ergometrine-0.25mg/0.5mg ampoules
& 0.5-1mg tablets
• Methylergometrine - 0.2 mg ampoules &
0.2mg tablets
• Syntometrine - 0.5 mg Ergometrine +
syntocinon 5.0 units ampoules available for
IM injection
ERGOT DERIVATIVES-INDICATIONS B
Therapeutic L
 To stop the atonic uterine bleeding A
following C
delivery K
 Inevitable/incomplete abortion B
O
 Following expulsion of hydatidiform A
mole R
 During MTP Explainig and D
 Subinvolution of uterus questioning Listening and &
Prophylactic As a prophylaxis against answering P
P
excessive hemorrhage However now
oxytocin is used for this indication T
ERGOT DERIVATIVES-
CONTRAINDICATIONS
like
 Cardiac disease
 Severe Pre-eclampsia & Eclampsia
 After delivery of 1st twin
 Maternal vascular disease
disease and atherosclerosis
 Rh negative mother
Raynaud’s
B
ERGOT DERIVATIVES- SIDE L
EFFECTS A
• Nausea and vomitting Explainig and C
• Headache,confusion and depression questioning Listening and K
• Hour glass contraction of uterus answering B
• Hypertension and MI O
A
• Peripheral vascular disease
R
D
ERGOT DERIVATIVES-DOSE & &
ROUTE P
For active management of 3rdstage of P
T
labour-
 0.2mg (1 amp) to be given IM.
For control of atonic PPH-
1 amp slowly over 60 seconds, may be
repeated after 2hrs.
10mins For excessive lochia and subinvolution-
1 Tablet(0.125mg)TDS for 3 days. Explainig and
questioning Listening and
ERGOT DERIVATIVES- NURSING answering
Enumerate the CONSIDERATIONS
prostaglandins • Assess patient BP, pulse, respiration, signs B
L
of A
hemorrhage C
• Administer Orally/IM deep, having K
emergency B
cart readily available O
A
• Evaluate therapeutic effect of decrease R
blood loss D
• Teach patient/family to report for &
increased blood loss, abdominal cramps, P
headache, sweating, nausea, vomiting/ P
dyspnea T
PROSTAGLANDINS-PREPARATIONS
& ADMINISTRATION
Prostaglandin E2 is widely used because it
is less toxic and more effective than PGF2ά.
However it is costly and requires
refrigeration.
• PGE2– Prostin E2 (Dinoprostone) Gel- B
0.5mg/500mcg in 2.5ml,comes in pre loaded L
syringe inserted into cervical canal, below A
the level of internal os or 1-2 mg in C
posterior fornix. K
PROSTAGLANDINS-PREPARATIONS B
&ADMINISTRATION O
A
• Vaginal tablet- 3 mg Prostin E2 inserted in R
posterior fornix followed by 3 mg after 6-8 D
hours. &
• Vaginal pessary- releasing dinoprostone 10 P
mg over 24 hours. Removed after adequate P
cervical T
ripening.
PROSTAGLANDINS-PREPARATIONS
& ADMINISTRATION
Parenteral doses:
PGE2/ Prostin E2- containing 1mg/ml
PGF 2ά - Dinoprostone Tromethamine-
Containing 5mg/ml
PGF2ά (methyl analogue) –Carboprost B
Available as 1 ml ampoule Inj- 125 and L
250mcg for IM or intramyometrial use A
PROSTAGLANDINS-INDICATIONS C
• For induction of abortion K
B
• During 2nd trimester MTP & expulsion of O
hydatidiform mole A
• For induction of labor in IUD of fetus R
• In augmentation/ acceleration of labor D
• Treatment of atonic PPH &
• Cervical ripening P
PROSTAGLANDINS- P
T
CONTRAINDICATIONS
• Heart disease
• Uterine scar
• Hypersensitivity
• Severe preeclampsia
• Vascular disease
• Cervical stenosis
• PID
• Bronchial asthma
PROSTAGLANDINS- SIDE EFFECTS
• Severe bronchospasm
• Nausea, vomitting and diarrhoea
• Hypertonic uterine action
• Headache, Dizziness, confusion and
depression
• Hypertension and cardiac ischemia
Risks of Misoprost
• Uterine hyperstimulation
• Uterine rupture
• Adverse fetal heart rate, meconium
passage and meconium aspiration
PROSTAGLANDINS-NURSING
CONSIDERATIONS
 Assess patient RR, rhythm & depth,
vaginal
discharge, itching/ irritation indicative
of infection.
 Administer Antiemetic/ antidiarrheal
preparations
prior to giving this drug. Insert high in
vagina, after
warming the suppository by running
warm water
over package
 Evaluate patient for
contractions, notify
length
 physician
& duration of
of contractions
absence of contractions,lasting over 1
minute or
fever & chills
 Advise patient to remain supine for
10-15
minutes after vaginal insertion.
DIFFERENCE BETWEEN
PROSTAGLANDINS AND OXYTOCIN
• Prostaglandins contract uterine smooth
muscle not only at term(as withoxytocin),
but throughout pregnancy.
• Prostaglandins soften the cervix; whereas
oxytocin does not.
• Prostaglandins have longer duration of
actionthan oxytocin.

CONCLUSION
• No drug should be administered to a woman during pregnancy, labor and birth, unless the
woman is fully informed of the known risks and the relevant areas of uncertainty regarding the
effects of the drug on the physiologic and neurologic development of the woman or her baby
• The drugs that are used daily in obstetric can have a huge impact on the outcome of both
mother and child.
• Therefore, obstetric providers need to have a very clear understanding of the mechanism of
action, doses and side-effects of the most commonly used drugs