Uterotonics for PP Hemorrhage

Uterotonic medications

Pitocin

Methergine

Hemabate

Cytotec

TXA

Pitocin dose

10-40 units per 500-1000 mL

Rate titrated to uterine tone

Pitocin route

IV infusion

Pitocin frequency

Continuous

Pitocin side effects

Usually none

Nausea/vomiting

Hyponatremia with prolonged IV admin

Hypotension and Tachycardia in high doses (IVP)

Pitocin contraindications

Hypersensitivity to drug

Methergine dose

0.2 mg

Methergine route

IM

Not given IV

Methergine frequency

Q2-4 hours

If no response after first dose, it is unlikely that additional doses will be of benefit

Methergine side effects

Severe nausea vomiting

Hypertension - Especially with rapid administration or in pts with HTN

Methergine contraindications

Hypertension

Preeclampsia

Heart disease

Hypersensitivity to drug

Caution if multiple doses of ephedrine have been used

May exaggerate HTN response response w/ possible cerebral hemorrhage

Hemabate dose

250 mcg

Hemabate route

IM or intrauterine

Not given IV

Hemabate frequency

Q15-90 mins

If no response after 3 doses, it is unlikely that additional doses with be of benefit

Hemabate side effects

Nausea

Vomiting

Diarrhea

Fever (transient)

Headache

Chills

Shivering

HTN

Bronchospasm

Hemabate contraindications

Caution with women with hepatic disease

Asthma

HTN

Active cardiac or pulmonary disease

Hypersensitivity to drug

Cytotec dose

600-800 mcg

Cytotec route

SL or PO

Cytotec frequency

One time

Cytotec side effects

Nausea, vomiting

Diarrhea

Shivering

Fever (transient)

Headache

Cytotec contraindications

Rare

Known allergy to prostaglandin

Hypersensitivity to drug

TXA dose

1 gram

TXA route

IV infusion over 10 mins

TXA frequency

One dose within 3 hrs of hemorrhage recognition

A 2nd dose may be administered if bleeding continues after 30 mins or if bleeding stops and then restarts within 24 hrs of completing first dose

TXA side effects

Nausea, vomiting

Diarrhea

Hypotension if given too rapidly

TXA contraindications

A known thromboembolic event in pregnancy

Hx of coagulopathy

Active intravascular clotting