Labor and Delivery in the Emergency Department Medication
- Author: Thomas E Benzoni, DO; Chief Editor: Mark A Clark, MD more...
Medication Summary
Few drugs are needed in an uncomplicated delivery. If excessive bleeding occurs, first try massaging the uterus, because uterine atony is the most common cause of this complication. Do not try to push the uterus out the vaginal canal. Gently squeeze or compress the uterus to cause myofibrils to contract. This action compresses the vessels perforating the uterus. If this fails, try administering oxytocin (Pitocin), then prostaglandin F2.
Oxytocics
Class Summary
These agents are used to reduce postpartum bleeding.
Oxytocin (Syntocinon, Pitocin)
Produces rhythmic uterine contractions and can stimulate the gravid uterus; has vasopressive and antidiuretic effects; can control postpartum bleeding or hemorrhage by increasing postpartum myometrial tonus.
Methylergonovine (Methergine)
Acts directly on uterine smooth muscle, causing a sustained tetanic uterotonic effect that reduces uterine bleeding and shortens the third stage of labor. Administer IM during puerperium, delivery of placenta, or after delivering anterior shoulder. May also be given IV, over at least 60 sec, but should not be administered routinely (may provoke hypertension or a stroke). Monitor BP closely when administering IV.
National Center for Health Statistics. Vital Stats Births. Available at http://www.cdc.gov/nchs/datawh/vitalstats/VitalStatsbirths.htm. Accessed April 11, 2008.
CDC. Healthier mothers and babies. MMWR Morb Mortal Wkly Rep. Oct 1 1999;48(38):849-58. [Medline]. [Full Text].
Frew S. MedLaw. Available at www.medlaw.com.
[Guideline] ACOG Committee on Ethics. Innovative practice: Ethical Guidelines. [Full Text].
Danforth DN. Obstetrics and Gynecology. 4th ed. Philadelphia, Pa: Harper and Row; 1982.
Mifsud AJ, Efstratiou A, Charlett A. Early-onset neonatal group B streptococcal infection in London: 1990-1999. BJOG. Sep 2004;111(9):1006-11. [Medline].
Willson JR. Atlas of Obstetric Technic. 2nd ed. St Louis, Mo: Mosby; 1969.

