The intravenous use of dilute Pituitrin for the induction and stimulation of labor: A preliminary report

Abstract

T HE use of Pituitrin in labor dates from 1909 when Blair Bell’ described the results which might be expected from its use in postpartum hemorrhage, and in 1911 when Hofbaue? suggested its use in uterine inertia. As might be expected from its ability to initiate and maintain strong and regular uterine contractions, it was immediately popularized and the indications for its employment broadened until reports of accidents caused it to be roundly condemned. So it was that in 1920 obstetrical opinion was almost unanimous in decrying the administration of the drug. Most of the objections to its use stemmed from unreliable standardization or from the use of relatively huge doses in the first and second stages of labor. Nevertheless, especially in hospitals unassociated with the large teaching centers, Pituitrin continues to be used, and, I might add from personal observation, abused, sometimes with disastrous results for both mother and fetus. In an effort to minimize accidental overdosage it was suggested by Hofbauer3 that the drug might be administered intranasally by inserting saturated cotton pledgets into the nostrils. This method enjoyed a certain popularity for a limited time but results were soon found to be unreliable due to individual variation in the rates of absorption. Furthermore, the method was most unpleasant to the patient. Uterine tetany and even uterine rupture occurred with intranasal administration so that in addition to its unpredictability it was found to be unsafe.5 The very fact that Pituitrin has been used, condemned, and again studied in the past forty years despite the dangers which have been associated with its use indicates that there is a need for a reliable method of treatment of uterine inertia and a safe and efficient method of induction of labor when obstetrical indications for the termination of pregnancy exist. Reid4 in 1946 and Eastman5 in 194’7 acknowledged this need and showed that with appropriate safeguards in carefully selected cases, the use of Pituitrin in labor could be genuinely beneficial with no serious complications. Nevertheless, there was a certain percentage of cases in which Pituitrin failed to initiate contractions or was inadequate to maintain them at an effective level.