Postpartum Hemorrhage - Differential Diagnosis, Examination and Management Uterotonic Medications (after delivery of the placenta): • Oxytocin (causes uterine contraction): 10 IU IM or 20 IU in 500 mL IV fluids at 250 mL/hr • RAPID IV INFUSION IS ASSOCIATED WITH CARDIOVASCULAR COLLAPSE • Methylergonovine (causes uterine contraction): 0.2 mg IM (avoid in preeclampsia or hypertension) • Carboprost (prostaglandin that induces uterine contraction: 0.25 mcg IM q15 min up to 2 mg (8 doses) • Misoprostol (prostaglandin that induces uterine contraction): 600-1000 mcg oral/rectal • OFF LABEL USE Methods of Tamponade: • Balloon uterine tamponade device (Bakri) • Foley catheter is not large enough to provide tamponade • Uterine packing may not be effective as the uterus may create and large potential space Surgical/Vascular Intervention: • Hysterectomy • Uterine Artery Embolization by Stacy Marshall, MD #Postpartum #Hemorrhage #Differential #Diagnosis #Examination #Management #Medications
