Postpartum Hemorrhage in Emergency Medicine Medication

Updated: Dec 16, 2016
  • Author: Maame Yaa A B Yiadom, MD, MPH; Chief Editor: Bruce M Lo, MD, MBA, CPE, RDMS, FACEP, FAAEM, FACHE  more...
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Medication

Medication Summary

Medications used to control postpartum hemorrhage (PPH) are in the category of uterotonic drugs. These drugs stimulate contraction of the uterine muscle, helping to control PPH.

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Uterotonics

Class Summary

These agents are useful in the treatment and prophylaxis of PPH. The information below applies only following delivery of the fetus (the dosing, indications, and contraindications will vary prior to delivery).

Oxytocin (Pitocin)

Produces rhythmic uterine contractions, can stimulate the gravid uterus, and has vasopressive and antidiuretic effects. Can be used to control postpartum bleeding or hemorrhage. Some suggest its prophylactic use in the third stage of labor; one study of 1000 deliveries revealed a 32% reduction in the rate of PPH.

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 or intramyometrially during puerperium, during delivery of placenta, or after delivering anterior shoulder.

Carboprost (Hemabate)

Prostaglandin similar to F2-alpha, but it has a longer duration and produces myometrial contractions that induce hemostasis at the placentation site, which reduces postpartum bleeding.

Misoprostol (Cytotec)

Synthetic prostaglandin E 1 analog.

Ergonovine (Ergotrate Maleate)

Used to prevent and treat PPH due to uterine atony by producing firm contraction of the uterus within minutes. Although it is intended primarily for IM administration, a faster response can be achieved with IV use. Compared with IM route, IV route has a higher incidence of adverse effects; IV use should be reserved for emergencies (eg, excessive uterine bleeding). Severe uterine bleeding may require repeated doses, but it seldom requires more than one injection q2-4h.

Recombinant factor VIIa (NovoSeven)

Man-made activated protein that promotes thrombosis.

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