INTRODUCTION
Dosage calculation for oxytocin is crucial in the induction of labor for patients at 41 weeks of
pregnancy. Learn the proper starting rate for the intravenous infusion and the titration process
necessary to ensure effective labor progression.
The labor and delivery nurse is preparing to initiate an intravenous infusion of oxytocin to induce
labor in a patient who is 41 weeks pregnant.
The healthcare provider prescribes the infusion to begin at one (1) milliunits (mUnits)/min to be
titrated every fifteen minutes by an increment of 2 mUnit per minute until labor has progressed
and the patient is five centimeters (cm) dilated.
Usual Adult Dose for:
Labor Augmentation
Labor Induction
Postpartum Bleeding
Abortion
Additional dosage information:
Renal Dose Adjustments
Liver Dose Adjustments
Precautions
Dialysis
Other Comments
Usual Adult Dose for Labor Augmentation
Initial dose: 0.5 to 1 milliunits/minute via IV infusion
Gradually increase dose in increments of 1 to 2 milliunits at 30 to 60 minute intervals
until the desired contraction pattern has been established
Once desired frequency of contractions has been reached and labor has progressed to 5 to
6 cm dilation, the dose may be reduced by similar increments
Usual Adult Dose for Labor Induction
Initial dose: 0.5 to 1 milliunits/minute via IV infusion
Gradually increase dose in increments of 1 to 2 milliunits at 30 to 60 minute intervals
until the desired contraction pattern has been established
Once desired frequency of contractions has been reached and labor has progressed to 5 to
6 cm dilation, the dose may be reduced by similar increments
Usual Adult Dose for Postpartum Bleeding
Add 10 to 40 units to running infusion (depending on amount of electrolyte or dextrose
solution remaining)
Adjust infusion rate to sustain uterine contraction and control uterine atony
Usual Adult Dose for Abortion
Following suction or sharp curettage for an incomplete, inevitable, or elective abortion: 10 units
in 500 mL IV infusion; adjust rate to assist uterus in contraction
Following intra-amniotic injection for midtrimester elective abortion: 10 to 20 milliunits/minute
via IV infusion may shorten the injection-to-abortion time
Maximum dose: 30 units in a 12 hour period due to the risk of water intoxication
CONTRAINDICATIONS:
Hypersensitivity to the active substance
Significant cephalopelvic disproportion
Unfavorable fetal positions or presentations, such as transverse lies, which are
undeliverable without conversion prior to delivery
Obstetrical emergencies where the benefit-to-risk ratio for either the fetus or the mother
favors surgical intervention
Fetal distress where delivery is not imminent
Prolonged use in uterine inertia or severe toxemia
Hyperactive or hypertonic uterus
In cases where vaginal delivery is contraindicated, such as invasive cervical carcinoma,
active herpes genitalis, total placenta previa, vasa previa, and cord presentation or
prolapse of the cord
Safety and efficacy have not been established in patients younger than 18 years.
DOSAGE CALCULATION
The medication is prepared in an infusion bag that contains 30 units of oxytocin in 1 liter (L)
lactated ringers. At which rate (mL/hr) should the nurse initiate the infusion?
Note that 1 unit = 1000 mUnits
Units Round to the nearest whole number.
Use a leading zero if it applies. Don’t use a trailing zero.
Any rounding should be completed at the end of the calculation.
The answer must be numeric only. Don’t add any units of measurement.
ADMINISTRATION OF OXITOCIN
Oxytocin can be administered intravenously (IV) or intramuscularly (IM). Intravenous
administration is typically preferred for labor induction and augmentation, while intramuscular
administration is often used for postpartum hemorrhage prevention or management. According to
the World Health Organization (WHO), intravenous oxytocin reduces the risk of postpartum
hemorrhage, severe postpartum hemorrhage, blood transfusion, and severe maternal morbidity
compared to intramuscular administration, but it may also impose additional resource
requirements and impact comfort.
Intravenous (IV) Administration:
Labor Induction/Augmentation:
Oxytocin is diluted in a physiological electrolyte solution (like 0.9% sodium chloride) and
administered via an IV infusion pump. The rate is typically started low and gradually increased
until effective contractions are achieved.
Postpartum Hemorrhage Prevention:
A 10 IU dose of oxytocin can be administered intravenously after vaginal delivery or cesarean
section.
Onset of Action:
Uterine contractions begin within about 1 minute of IV administration and can persist for
around 1 hour.
Monitoring:
Close monitoring of contractions and fetal status is crucial during IV oxytocin administration,
with adjustments made based on the situation.
Dose Adjustment:
The dosage of oxytocin may be adjusted depending on the patient's contraction pattern and any
side effects experienced, according to MedlinePlus.
Intramuscular (IM) Administration:
Postpartum Hemorrhage Management:
Oxytocin can be administered intramuscularly for postpartum hemorrhage prevention or
management,.
Onset of Action:
Uterine contractions begin within 3 to 5 minutes of IM administration and can last up to 3
hours.
Ease of Administration:
IM administration is easier to administer and requires less skill than IV administration.
Dose:
A standard dose of 10 IU of oxytocin is typically used.
Important Considerations:
Monitoring: Careful monitoring of uterine contractions and fetal heart rate is essential
during oxytocin administration.
Side Effects: Oxytocin can cause uterine hypertonicity, spasm, tetanic contractions, or
even rupture of the uterus in rare cases, especially with excessive dosage or
hypersensitivity.
Fetal Compromise: If fetal status is nonreassuring, oxytocin administration should be
discontinued.
Water Intoxication: Excessive use of oxytocin can lead to water intoxication, potentially
causing seizures and coma.
Dose Adjustment: The dosage of oxytocin may need to be adjusted based on individual
patient needs and response to the medication.
Hospitals are the preferred location for oxytocin administration, according to PCMCH.
Staff should be readily available 24/7/365 to manage potential patient harm incidents.
Quick access to an operating room for urgent cesarean section procedures is also
recommended
BIBLIOGRAPHY
1. Goodman & Gilman's: The Pharmacological Basis of Therapeutics
(Latest Edition). Brunton, L. L., Chabner, B. A., & Knollmann, B. C. McGraw-
Hill Education. This comprehensive pharmacology textbook provides the
fundamental principles of drug action, pharmacokinetics, and pharmacodynamics,
essential for understanding oxytocin's effects and appropriate dosing.
2. Basic and Clinical Pharmacology (Latest Edition). Katzung, B. G., & Trevor, A.
J. McGraw-Hill Education. Another widely used pharmacology textbook covering
drug calculations and administration principles.
3. Clinical Calculations: A Unified Approach (Latest Edition). Olsen, A.
M., Giangrasso, A. K., & Shrimpton, D. Saunders/Elsevier. A dedicated textbook
focusing on drug dosage calculations, including intravenous infusions, which are
relevant to oxytocin administration.
4. Brown, M. M., & Mulholland, J. Lippincott Williams & Wilkins. Another
resource specifically focused on drug calculation methods.
