Info

Drug Class

Dosage

Description

Rationale

Oxytocin (Pitocin)

Mix 10-40 U in 1000 cc, give 20-40 mU/min

Oxytocic

Controls bleeding by producing uterine contractions

Methylergonovine (Methergine)

0.2 mg IM

Oxytocic

Controls bleeding by producing uterine contractions

Carboprost

Misoprostol (recent studies suggest use)

Varies by drug

Prostoglandin

Used when oxytocin and methylergonovine are not effective in producing contractions

Independent

Be alert for PPH in any postpartum patient, especially those who have any of the predisposing factors. It is often the nurse who discovers the hemorrhage. For the first 24 hours postpartum, perform frequent fundal checks. If the fundus is boggy, massage until it feels firm; it should feel like a large, hard grapefruit. When massaging the fundus, keep one hand above the symphysis pubis to support the lower uterine segment, while gently but firmly rubbing the fundus, which may lose its tone when the massage is stopped. Explain that cramping or feeling like "labor is starting again" is expected with liberal administration of the oxytocic drugs used to manage the bleeding. Monitor for hypertension if oxytocics and prostaglandins are used. Encourage the patient to void; a full bladder interferes with contractions and normal uterine involution. If the patient is unable to void on her own, a straight catheterization is necessary.

Monitor vaginal bleeding; the lochia is usually dark red and should not saturate more than one perineal pad every 2 to 3 hours. Notify the physician if the bleeding is steady and bright red in the presence of a normal firm fundus; this usually indicates a laceration. Ice packs and sitz baths may relieve perineal discomfort. The patient is usually on complete bedrest. Rooming in with the infant may be difficult; provide for safe care for the infant while it is in the mother's room. Assist the patient and significant others as much as possible with newborn care to facilitate quality time between the mother and her newborn. Assist the patient with ambulation the first few times out of bed; syncope is common after a large blood loss. Ensure adequate rest periods.

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