Indications: induction and augmentation of labor; management of missed or incomplete abortion; post- partum haemorrhage.

Cautions: hypertension, pressor drugs, multiple pregnancy, high parity, previous caesarean section. particular caution needed when given for induction or enhancement of labour in presence of borderline cephalopelvic disproportion, pregnancy-induced hypertension both mild or moderate, cardiac disease, women over 35 years or with history of lower-uterine segment caesarean section; water intoxication and hyponatraemia—avoid large infusion volumes and restrict fluid intake by mouth; effects enhanced by concomitant prostaglandins (very careful monitoring), caudal block anaesthesia (may enhance hypertensive effects of sympathomimetic vasopressors).

Contra-indications: hypertonic uterine contractions, fetal distress; any condition where spontaneous labour or vaginal delivery inadvisable; avoid prolonged administration in oxytocin-resistant uterine inertia, severe pre-eclamptic toxaemia or severe cardiovascular disease.

Side Effects: uterine spasm (may occur at low doses), uterine hyperstimulation (usually with excessive doses— may cause fetal distress, asphyxia and death, or may lead to hypertonicity, tetanic contractions, soft-tissue damage or uterine rupture); water intoxication and hyponatraemia associated with high doses with large infusion volumes of electrolyte-free fluid; also nausea, vomiting, arrhythmias; rashes and anaphylactoid reactions (with dyspnea, hypotension or shock) also reported; placental abruption and amniotic fluid embolism also reported on overdose.

Dose: by slow IV infusion, induction and augmentation of labor, as a solution containing 5 units in 500ml of a physiologic electrolyte solution, 1-4 milliunits per minute, adjusted according to response.

Incomplete, inevitable or missed abortion, by slow IV injection, 5 units followed if necessary by IV infusion, 0.02-0.04 units/minute or faster.

Treatment of post-partum haemorrhage, by slow IV injection, 5 units, followed in severe cases by IV infusion of 5-20 units/500ml given at a rate of 15 drops/ minute, adjusted according to response.

Prevention of post-partum hemorrhage, after delivery of placenta, by slow IV injection, 5 units (if infusion used for induction or enhancement of labour, increase rate during third stage and for next few hours).

Induction of labour for medical reasons or stimulation of labour in hypotonic uterine inertia, by intravenous infusion, max. 5 units in 1 day (may be repeated next day starting again at 0.001–0.002 units/minute).

Important: Careful monitoring of fetal heart rate and uterine motility essential for dose titration (avoid intravenous injection during labour); discontinue immediately in uterine hyperactivity or fetal distress Caesarean section, by slow intravenous injection immediately after delivery, 5 units.

Prevention of postpartum haemorrhage, after delivery of placenta, by slow intravenous injection, 5 units (if infusion used for induction or enhancement of labour, increase rate during third stage and for next few hours).

Note: May be given in a dose of 10 units by intramuscular injection instead of oxytocin with ergometrine.

Treatment of postpartum haemorrhage, by slow intravenous injection, 5–10 units, followed in severe cases by intravenous infusion of 5–30 units in 500ml infusion fluid at a rate sufficient to control uterine atony.

Important: Avoid rapid intravenous injection (may transiently reduce blood pressure); prolonged administration.

Incomplete, inevitable or missed abortion, by slow intravenous injection, 5 units followed if necessary by intravenous infusion, 0.02–0.04 units/minute or faster Prolonged intravenous administration at high doses with large volume of fluid (as possible in inevitable or missed abortion or postpartum haemorrhage) may cause water intoxication with hyponatraemia. To avoid: use electrolyte-containing diluent (i.e. not glucose), increase oxytocin concentration to reduce fluid, restrict fluid intake by mouth; monitor fluid and electrolytes.