clinical equipoise

 From the reproductive system: at high doses or hypersensitivity – Uterine hypertension, cramps, tetany, uterine rupture, increased bleeding in the postpartum period due to oxytocin-induced thrombocytopenia, hypoprothrombinemia afibrinogenemia and sometimes bleeding in the pelvic organs. With clinical equipoise careful medical supervision for childbirth bleeding risk in the postpartum period is reduced.

Since the cardiovascular system: at high doses – an arrhythmia; ventricular premature beats; severe hypertension (in the case of the use of vasopressor agents); hypotension (while the use of anesthetic cyclopropane); reflex tachycardia; shock; at too rapid introduction: bradycardia, subarachnoid hemorrhage. On the part of the digestive system: nausea, vomiting. From the water-electrolyte metabolism: heavy hyperhydration with prolonged intravenous administration (typically 40-50 mU / min) with plenty of fluid (antidiureticheskoy effect of oxytocin ), flowing with convulsions and coma is possible with 24-hour, slow infusion of oxytocin; . rarely – death Immune system: anaphylaxis and other allergic reactions, at too rapid introduction of bronchospasm; rarely – death

Fetus or newborn: As a consequence of the introduction of the mother oxytocin – within 5 minutes of low Apgar score, neonatal jaundice, at too rapid introduction – a decrease of fibrinogen in the blood of the fetus, bleeding in the retina of the eye; thus strengthening the contractile activity of the uterus – sinus bradycardia, tachycardia, ventricular premature beats and other arrhythmias, residual changes in the central nervous system, fetal death due to asphyxia.

Overdosing
Symptoms depend mainly on the degree of uterine hyperactivity, regardless of the presence of hypersensitivity to the drug. Hyperstimulation with hypertensive and tetanic contractions or with a basic tone ≥15-20 mm aq. Art. between the two contractions leads to a disorderly labor, rupture of the body or the cervix, vagina, bleeding in the postpartum period, the utero-placental insufficiency, fetal bradycardia, its hypoxia, hypercapnia, compression, birth injuries or death. Hyperhydration with cramps as a result of the antidiuretic effect of oxytocin is a serious complication develops during prolonged administration of large doses (40-50 ml / min).
The treatment of fluid overload: the abolition of oxytocin, the liquid consumption limitation, use of diuretics to force diuresis, intravenous hypertonic saline, correction electrolyte imbalance, treatment of seizures appropriate doses of barbiturates and providing professional care of a patient in a coma.

Drug Interactions
When administered oxytocin 3-4 hours after the application of vasoconstrictor in conjunction with caudal anesthesia can be severe hypertension.
Anesthesia cyclopropane, clinical equipoise halothane may change the cardiovascular actions of oxytocin from the unexpected development of arterial hypotension, sinus bradycardia and atrioventricular rhythm in mothers during anesthesia.

Special instructions:
Before proceeding to the use of oxytocin should be weighed against the expected beneficial effect of treatment with the possibility, albeit rare, of developing hypertension and uterine tetany.
Prior to insertion of the fetal head in the pelvis input use oxytocin to induce labor is impossible.
Each patient receiving oxytocin intravenously, It should be in a hospital under constant supervision of experienced professionals, familiar with the preparation and recognized skilled in recognizing complications. It must be immediate, if necessary, assistance of a specialist. During the use of the drug should constantly monitor uterine contractions, heart activity mother and the fetus, blood pressure mothers to avoid complications. When symptoms of uterine hyperactivity, stop administration of oxytocin; as a result, uterine contractions caused by the drug, usually subside soon.
With adequate use of oxytocin causes uterine contractions, similar spontaneous birth. Over-stimulation of the uterus due to incorrect use of the drug is dangerous for pregnant woman and the fetus. Even with adequate use of the drug and an appropriate observation hypertonic uterine contractions occur when increased sensitivity of the uterus to oxytocin.
It should be considered at risk of developing afibrinogenemia and increase blood loss.
There are cases of mothers death due to hypersensitivity reactions, subarachnoid hemorrhage, uterine rupture and fetal deaths due to various reasons associated with parenteral drug administration for labor induction and stimulation in the first and second stages of labor.
As a result of the antidiuretic effect of oxytocin may develop overhydration, especially when using a constant infusion of oxytocin and ingested fluids.
The drug can be diluted in sodium lactate solution, sodium chlorate and glucose. Ready to use solution should be in the first 8 hours after preparation. Compatibility studies were carried out with the infusion volume of 500 ml. The drugs clinical equipoise on driving ability and mechanisms, work on which is connected with an increased risk of injury: oxytocin has no effect on ability to drive and mechanisms, work on which is associated with an increased risk of injury.

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