Use of buccal oxytocin in induction of labour in Chinese patients.

The use of intravenous oxytocin infusion in "physiological doses" as advocated by Theobald et al. (1948) is one of the advances made in obstetric practice in recent years. It is a safe and effective method of induction of labour. There are, however , certain disadvantages associated with its use: (1) it immobilizes the patient; (2) some patients are frightened by the infusion apparatus; (3) the infusion may cause a local phlebitis; and (4) close and constant supervision for many hours is required. Other methods of administration of the drug have been used or suggested. Intramuscular injections, which were used extensively before intravenous infusion was introduced , have been shown to be associated with considerable risks-for example, uterine rupture. Oral administration is value-less, as oxytocin is rapidly destroyed by the gastric juice. Oxytocin is absorbed by buccal and nasal mucosa, and administration through them has been used. Dillon et al. (1960) had success with synthetic oxytocin by placing the pellets in the upper buccal sulcus on either side of the mouth, thus avoiding destruction of the drug by saliva and gastic secretion and preserving its activity. This method of administration is acceptable to the patient. It has been proved to be effective, but its safety compared with the intravenous infusion method has not yet been established. This report gives the results of an investigation into its use in Chinese patients, most of whom object strongly to intravenous infusions. Method and Administration It was planned to administer buccal oxytocin (Pitocin) citrate to 50 consecutive patients in Tsan Yuk Maternity Hospital who were to be induced and whose cervices were unripe. After the drug had been given to 19 patients the trial was stopped because of the risks to mother and foetus. The indications for induction in these 19 patients were as follows: toxaemia of pregnancy in 15, post-maturity in 2, and prolonged leakage of liquor in 2. The ages of the 19 patients varied from 19 to 34 (average 26), and 16 were primiparae and 3 multiparae. The maturity at the time of induction was over 37 weeks in all cases. The presentation was vertex in 18 cases and breech in one case. In all cases buccal oxytocin citrate alone was used for induction. Oxytocin-sensitivity test (Eddie, 1963) was done in all cases to find if it could be used to predict the chances of successful induction. A 10-ml. syringe containing 0.1 …