PPH management - drug therapy:
• Oxytocin
---• 5 units IV bolus
---• 20-40 units/250mL in crystalloid
---• 10 units IM if CV collapse or no IV access
• Carbetocin (long-acting oxytocin)
---• 100ug IV/IM
• Hemabate (Carboprost/15-Methyl Prostaglandin F2a)
---• 250 ug IM or intramyometrial; repeat every 15 min as needed
---• Maximum cumulative dose 2 mg (8 doses)
---• Asthma a relative contraindication
• Methylergonovine maleate
---• 0.25 mg IM/0.125 mg IV
---• Repeat every 5 mins as needed
---• Maximum 5 doses
---• Hypertension and some medications (eg proteases) are a contraindication
• Misoprostol (off-label use)
---• 600-800 ug po/sl (faster onset) or pr/pv
---• Side effect: Pyrexia if >600ug given
• Tranexamic Acid (cyklokapron)—antifibrinolytic
---• 1g IV