The drip is regulated by—

(1) Manually, counting the drops per minute commonly practiced.

(2) Oxytocin infusion pump which automatically controls the amount of fluid to be infused.

Convenient regime:
Because of wide variation in response, it is a sound practice to start with a low dose (1–2
mIU/min) and to escalate by 1–2 mIU/min at every 20 min intervals up to 8 mIU/min.
The patient should preferably lie on one side or in semi-Fowler’s position to minimize
venacaval compression.

High-dose oxytocin begins with 4 mIU/min and increased 4 mIU/min at every 20–30 min
interval. It is mainly used for augmentation of labor and in active management of labor. Risks
of uterine hyperstimulation and fetal heart irregularities are more with high-dose regime.

In majority of cases, a dose of less than 16 mIU/min (2 units in 500 mL Ringer solution
with drop rate of 60/minute) is enough to achieve the objective. Conditions where fluid
overload is to be avoided, infusion with high concentration and reduced drop rate is
preferred

 For augmentation of labor

Oxytocin infusion is used during labor in uterine inertia or for augmentation of labor or in the
active management of labor .The procedure consists of low rupture of the membranes
followed by oxytocin infusion when the liquor is clear. Fetopelvic disproportion must be
ruled out beforehand.
Indications of stopping the infusion
(1) Nature of uterine contractions—
(a) Abnormal uterine contractions occurring frequently (every 2 minutes or less) or
lasting more than 60 sec (hyperstimulation) or polysystole.
(b) Increased tonus in between contractions.
(2) Evidences of fetal distress
(3) Appearance of untoward maternal symptoms

NURSE’S RESPONSIBILITIES:
• Maintain the rate of flow of infusion according to the uterine response, to avoid hyper-
stimulation.
• Uterine contractions—number of contractions per 10 min duration of contraction and
period of relaxation are noted. ‘Fingertip’ palpation for the tonus of the uterus in between
contractions may be done where gadgets are not available.
• Peak intrauterine pressure should be monitored by using intrauterine pressure monitor.
Peak intrauterine pressure of 50–60 mm Hg with a resting tone 10–15 mm Hg is optimum
when intrauterine pressure monitoring is used .
• FHR monitoring should be done by auscultation at every 15 minutes interval or by
continuous electronic foetal monitoring.
• Assessment of progress of labour should be done (descent of the head and rate of cervical
dilatation)
• Help the client to use breathing exercises to manage her contractions (pain).
• After achieving the adequate number of contractions, Oxytocin infusion should be
maintained in a slow rate (<10 drops).
 Rate of flow of infusion by counting the drops per minute or monitoring the pump.