Labor and Delivery in the Emergency Department Medication

  • Author: Thomas E Benzoni, DO; Chief Editor: Mark A Clark, MD   more...
 
Updated: May 3, 2011
 

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.

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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.

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Contributor Information and Disclosures
Author

Thomas E Benzoni, DO  Medical Director of Mercy Air Care; Attending Staff, Department of Emergency Medicine, Mercy Medical Center; Member, Board of Directors, Iowa Medical Society; Medical Director, DMAT-B; Medical Manager, IA TF-1 USAR.

Thomas E Benzoni, DO is a member of the following medical societies: American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, American Osteopathic Association, and Iowa Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Assaad J Sayah, MD  Chief, Department of Emergency Medicine, Cambridge Health Alliance

Assaad J Sayah, MD is a member of the following medical societies: National Association of EMS Physicians

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Mark Zwanger, MD, MBA  Assistant Professor, Department of Emergency Medicine, Jefferson Medical College of Thomas Jefferson University

Mark Zwanger, MD, MBA is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and American Medical Association

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Mark A Clark, MD  Assistant Clinical Professor of Medicine, Columbia University College of Physicians and Surgeons; Program Director, Emergency Medicine Residency, St Luke's/Roosevelt Hospital Center

Mark A Clark, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

References
  1. National Center for Health Statistics. Vital Stats Births. Available at http://www.cdc.gov/nchs/datawh/vitalstats/VitalStatsbirths.htm. Accessed April 11, 2008.

  2. CDC. Healthier mothers and babies. MMWR Morb Mortal Wkly Rep. Oct 1 1999;48(38):849-58. [Medline]. [Full Text].

  3. Frew S. MedLaw. Available at www.medlaw.com.

  4. [Guideline] ACOG Committee on Ethics. Innovative practice: Ethical Guidelines. [Full Text].

  5. Danforth DN. Obstetrics and Gynecology. 4th ed. Philadelphia, Pa: Harper and Row; 1982.

  6. 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].

  7. Willson JR. Atlas of Obstetric Technic. 2nd ed. St Louis, Mo: Mosby; 1969.

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