PPH Meds

What is the indication for carbetocin in obstetrics?

Treatment of postpartum hemorrhage (PPH) as a 2nd or 3rd line agent.

What is the standard dose of carbetocin for PPH?

100 micrograms (mcg).

How is carbetocin administered?

IM or slow IV (over 30–60 seconds).

How often can carbetocin be given?

Single dose only (not repeated).

What are the contraindications for carbetocin?

Pregnancy, hypersensitivity, serious cardiovascular disorders.

What are the common adverse reactions to carbetocin?

Feeling of warmth, headache, nausea, vomiting, hypotension, flushing, pruritus (especially after cesarean birth).

What is the indication for Hemabate (carboprost)?

Treatment of postpartum hemorrhage (PPH).

What is the standard dose of Hemabate?

0.25 mg.

By which routes can Hemabate be administered?

IM or intramyometrial (IMM).

How frequently can Hemabate be given?

Every 15 minutes as needed.

What is the maximum cumulative dose of Hemabate?

2 mg (8 doses).

What are the contraindications for Hemabate?

Active cardiac, pulmonary, or renal disease; asthma; active pelvic inflammatory disease; hypersensitivity to prostaglandins.

What are the common adverse reactions to Hemabate?

Nausea, vomiting, diarrhea, abdominal pain, pyrexia, bronchospasm.

What is the indication for ergonovine in obstetrics?

Treatment of postpartum hemorrhage (PPH).

What is the standard dose of ergonovine?

0.25 mg.

What is the preferred route of administration for ergonovine?

Intramuscular (IM).

How often can ergonovine be repeated, and what is the maximum number of doses?

Every 2 hours, up to 5 doses total.

What is the onset time for ergonovine?

2–5 minutes.

What are the contraindications for ergonovine?

Hypertension, preeclampsia, eclampsia, hypersensitivity to ergonovine, or concurrent HIV treatment with protease inhibitors or NNRTIs.

What are the common adverse reactions to ergonovine?

Nausea, vomiting, hypertension, diarrhea, dizziness, abdominal pain, transient chest pain

What is the standard treatment dose of misoprostol for PPH?

400 mcg.

What is the preferred route of administration for misoprostol in PPH treatment?

Sublingual (SL).

How often can misoprostol be given for PPH treatment?

Single dose (x1)

What is the maximum dose of misoprostol for PPH treatment?

Do not exceed 1000 mcg.

What is the onset time of action for misoprostol when used for PPH treatment?

~11 minutes.

What is the main contraindication for misoprostol use?

Allergy or hypersensitivity to prostaglandins.

What are the common adverse reactions to misoprostol?

Pyrexia, chills (32–57%), nausea, vomiting, diarrhea (usually resolves in 2–6 hours).

How does dose affect side effects with misoprostol?

Side-effects increase with higher doses; pyrexia occurs in ~8% at ≤400 mcg vs 45% at ≥600 mcg

Why should high-dose misoprostol be used cautiously postpartum?

Pyrexia from higher doses can be mistaken for sepsis, leading to unnecessary interventions.

What is the oxytocin dose and route for PPH when given IM?

10 units IM

How soon does oxytocin work when given IM?

Onset: 2–3 minutes.

What is the oxytocin dose and route for PPH when given IV push?

3 units IV, pushed over >30 seconds.

What is the onset of oxytocin when given IV push?

Immediate.

What is the IV infusion dose of oxytocin for PPH?

20–40 units in 1000 mL IV fluids

How is an oxytocin IV infusion administered for PPH?

Start wide open, then titrate; rapid infusion over 4 minutes (≈3 IU bolus), then max 15 IU/hr.Do not exceed 3 L of fluids containing oxytocin.

What is the contraindication for oxytocin?

Hypersensitivity to oxytocin or drug class. (For IOL/augmentation: any contraindications to vaginal birth, fetal distress, etc.)

What are common maternal adverse reactions to oxytocin?

Nausea, vomiting, hypotension, headache, water intoxication (at high doses due to ADH-like effect), uterine rupture, anaphylaxis.

What fetal/neonatal complications can result from oxytocin overuse?

Tachysystole with or without FHR changes, decreased uterine blood flow, fetal distress, placental abruption

What rare but serious adverse outcomes can prolonged oxytocin infusion cause?

Water intoxication → headache, lethargy, seizures, unconsciousness.

What is the standard dose of TXA for PPH?

1 g IV over 10 minutes.

How should TXA be prepared and administered?

1 g in 10 mL (100 mg/mL), infused at 1 mL per minute over 10 minutes.

When should TXA be administered for best effectiveness?

Within 3 hours of birth.

When can a second dose of TXA be given?

If bleeding continues after 30 minutes, give a second 1 g IV dose.

What are the contraindications for TXA?

Hypersensitivity to TXA, history of thromboembolic event in pregnancy, subarachnoid hemorrhage.

What are the common adverse reactions to TXA?

Nausea, vomiting, visual disturbances, dizziness.