Medical management of postpartum hemorrhage

1. Oxytocin (Pitocin) is usually given routinely immediately after delivery to stimulate uterine firmness and diminish blood loss. 20 units of oxytocin in 1,000 mL of normal saline or Ringer's lactate is administered at 100 drops/minute. Oxytocin should not be given as a rapid bolus injection because of the potential for circulatory collapse.

2. Methylergonovine (Methergine) 0.2 mg can be given IM if uterine massage and oxytocin are not effective in correcting uterine atony and provided there is no hypertension.

3. 15-methyl prostaglandin F2-alpha (Hemabate), one ampule (0.25 mg), can be given IM, with repeat injections every 20min, up to 4 doses can be given if hypertension is present; it is contraindicated in asthma.

Treatment of Postpartum Hemorrhage Secondary to Uterine Atony

Drug

Protocol

Oxytocin

20 U in 1,000 mL of lactated Ringer's as IV infusion

Methylergonovine (Methergine)

0.2 mg IM

Prostaglandin (15 methyl PGF2-alpha [Hemabate, Prostin/15M])

0.25 mg as IM every 15-60 minutes as necessary

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