Prevention
| Medication | Dosage | Prevention | Treatment | Contraindications and cautions |
| Use with caution in patients with human ... | ||||
| Misoprostol (Cytotec), † a prostaglandin ... | Prevention: 600 mcg orally Treatment: 80 ... | Use only when oxytocin is not available | + | Use with caution in patients with cardio ... |
| Tranexamic acid (Cyklokapron) † | 1 g intravenously over 10 minutes, may b ... | – | + | Use within three hours of onset of bleed ... |
| Use with caution in patients with renal ... |
Is it recommended to take Cytotec for postpartum bleeding?
Misoprostol (Cytotec) may be used when other oxytocic agents are not available for prevention of postpartum hemorrhage (number needed to treat=18). Misoprostol may be used for treatment of postpartum hemorrhage, but this agent is associated with more side effects than conventional uterotonic drugs.
Do SSRIs increase the risk of postpartum hemorrhage?
That said, if we assume the estimates from the Palmsten study are correct, the use of SSRI antidepressants did not dramatically increase the risk of postpartum hemorrhage, measuring a 1.47-fold increase in risk. The authors estimate one additional case of postpartum hemorrhage for every 80 to 100 women treated with antidepressants.
How to prevent and treat postpartum hemorrhage?
Treatment for postpartum hemorrhage may include:
- Medication (to stimulate uterine contractions)
- Manual massage of the uterus (to stimulate contractions)
- Removal of placental pieces that remain in the uterus
- Examination of the uterus and other pelvic tissues
- Bakri balloon or a Foley catheter to compress the bleeding inside the uterus. ...
What is the mechanism of misprostal to postpartum bleeding?
Misoprostol- Indications and Mechanism of Action. Misoprostol is a synthetic prostaglandin medication that is used to start labor, prevent and treat stomach ulcers, cause abortion and stop postpartum bleeding caused by poor uterus contractions. It was developed in 1973 and is on the List of Essential Medicines of the World Health Organization.
What medications are used for postpartum hemorrhage?
The medications most commonly used in PPH management are uterotonic agents. These medications include oxytocin (Pitocin®), misoprostol (Cytotec®), methylergonovine maleate (Methergine®,), carboprost tromethamine (Hemabate®), and dinoprostone (Prostin E2®). All of these medications are available in the United States.
Which drug is used for treating a patient with severe postpartum bleeding?
Oxytocin is the most effective treatment for postpartum hemorrhage, even if already used for labor induction or augmentation or as part of active management of the third stage of labor.
When to use TXA for PPH?
TXA should be used in all cases of PPH, regardless of whether the bleeding is due to genital tract trauma or other causes.
What is PPH in birth?
ACOG defines PPH as cumulative blood loss ≥ 1,000 mL or blood loss accompanied by signs or symptoms of hypovolemia within 24 hours after the birth process (including intrapartum) regardless of route of delivery. Unfortunately, postpartum hemorrhage ( PPH) is still a leading cause of maternal mortality worldwide. Following this summary, you can find excellent professional resources at the California Maternal Quality Care Collaborative ( CMQCC) and ACOG District II Safe Motherhood Initiative sites.
What causes a PPH of 70-80%?
Uterine atony is the single most common cause of PPH (70-80%) Empty bladder, perform bimanual pelvic exam, remove clots and initiate uterine massage. If uterine atony is identified, the following drugs have been shown to be effective: NOTE: Contraindications include hypersensitivity to the specific medication.
How soon after birth can you administer TXA?
Administration of TXA should be considered as part of the standard PPH treatment package and be administered as soon as possible after onset of bleeding and within 3 hours of birth. The reference point for the start of the 3-hour window for starting TXA administration is time of birth.
How to manage PPH?
The key to managing PPH is identifying the severity of the situation early and quantifying estimated blood loss (EBL). A 2nd large bore (16 gauge or larger) should be placed and Ringers Lactate used to replace blood loss at 2:1 while, at the same time that the team is notified, medications are brought to the patient and massive transfusion protocol is initiat ed. Initiate fundal massage and place a Foley catheter.
When to use tranexamic acid?
Early use of intravenous tranexamic acid (within 3 hours of birth) in addition to standard care is recommended for women with clinically diagnosed postpartum haemorrhage following vaginal birth or caesarean section (Strong recommendation, moderate quality of evidence)
What is PIM in medical school?
Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity.
What is the treatment for postpartum hemorrhage?
Desaminooxytocin. Desaminooxytocin is used for the treatment of postpartum hemorrhage (excessive bleeding following delivery of the baby), to induce and augment labor and promote lactation.
What is the best medicine for uterine contractions?
Oxytocin. Oxytocin is a uterine stimulant, prescribed for the initiation of uterine contractions and induction of labor in women as well as stimulation of contractions in cases where the uterus does not contract enough during labor.
What is the drug used for trichomoniasis?
Metronidazole is an antibacterial agent, prescribed for trichomoniasis, amebiasis and other bacterial infections.
What is feracrylum used for?
Feracrylum is used as a hemostatic (to stop bleeding) and an anti-septic for the management of post-operative wounds, cuts, burns and abrasions.
What is a vaginal insert used for?
Used to ripen the cervix and induce labor. Usually administered as a vaginal insert that is removed at the start of active labor.
What is the preferred route for IV?
Subcutaneous route is preferred. IV use should be reserved for emergencies due to possible life threatening severe reactions.
Should RH antigen be given to women already sensitized to the RH antigen?
Should not be given to women who are already sensitized to the RH antigen
Can all meds be used for postpartum hemorrhage?
All may be used to treat postpartum hemorrhage.
What is the best medication for PPH?
The medications most commonly used in PPH management are uterotonic agents. These medications include oxytocin (Pitocin®), misoprostol (Cytotec®), methylergonovine maleate (Methergine®,), carboprost tromethamine (Hemabate®), and dinoprostone (Prostin E2®).14, 19, 21, 22, 31All of these medications are available in the United States. Only oxytocin, methylergonovine maleate, and carboprost tromethamine are approved by the U.S. Food and Drug Administration (FDA) specifically for PPH management; use of these other medications is off label. Typically, oxytocin is used as the initial medication for PPH management then other uterotonics are administered if oxytocin fails to stop bleeding. A recent U.S. study found wide variation in the use of these other uterotonics, which was not attributable to patient or hospital characteristics.32In cases of severe blood loss from PPH, the hemostatic recombinant activated factor VIIa (NovoSeven®) and the antifibrinolytic tranexamic acid (Cyklokapron®) have been used.33
What is PPH in perinatal care?
At a systems level, PPH has been the focus of perinatal care safety initiatives that attempt to improve patient outcomes by incorporating a variety of strategies, such as practice guidelines or protocols, simulation drills, and teamwork training. 34-38These systems-level interventions may influence management of PPH.
What is the most common etiology of PPH?
The most common etiology of PPH is uterine atony (impaired uterine contraction after birth), which occurs in about 80 percent of cases. Atony may be related to overdistention of the uterus, infection, placental abnormalities, or bladder distention.21Though the majority of women who develop PPH have no identifiable risk factors, clinical factors associated with uterine atony, such as multiple gestation, polyhydramnios, high parity, and prolonged labor, may lead to a higher index of suspicion.18, 19, 21, 22Other causes of PPH include retained placenta or clots, lacerations, uterine rupture or inversion, and inherited or acquired coagulation abnormalities.21, 22
What is PPH in pregnancy?
Postpartum hemorrhage (PPH) is commonly defined as blood loss exceeding 500 milliliters (mL) following vaginal birth and 1000 mL following cesarean.1 Definitions vary, however, and diagnosis of PPH is subjective and often based on inaccurate estimates of blood loss.1-4 Moreover, average blood loss at birth frequently exceeds 500 or 1000 mL,4 and symptoms of hemorrhage or shock from blood loss may be hidden by the normal plasma volume increases that occur during pregnancy. Proposed alternate metrics for defining and diagnosing PPH include change in hematocrit, need for transfusion, rapidity of blood loss, and changes in vital signs, all of which are complicated by the urgent nature of the condition.1 PPH is often classified as primary/immediate/early, occurring within 24 hours of birth, or secondary/delayed/late, occurring more than 24 hours post-birth to up to 12 weeks postpartum. In addition, PPH may be described as third or fourth stage depending on whether it occurs before or after delivery of the placenta, respectively.
How to treat PPH?
Interventions to treat PPH generally proceed from less to more invasive and include compression techniques, medications, procedures, and surgeries. PPH management may also involve adjunctive therapies, such as blood and fluid replacement and/or an anti-shock garment,26, 27to treat the blood loss and other sequelae that result from PPH. Conservative management techniques such as uterotonic medications, which cause the uterus to contract, external uterine massage, and bimanual compression are generally used as “first-line” treatments.28These compression techniques encourage uterine contractions that counteract atony and assist with expulsion of retained placenta or clots. Aortic compression is another compression technique that has been used for severe PPH.29, 30
What are the outcomes of PPH management?
Transfusion and anemia are sometimes used as markers for the amount of blood loss. The outcomes of intensive care unit (ICU) admission and extended hospitalization are used as indicators of maternal morbidity. Severe hemorrhage can lead to hysterectomy and death.
What are the procedures used for PPH?
Procedures used in PPH management include manual removal of the placenta, manual removal of clots, uterine balloon tamponade, and uterine artery embolization.14 , 19, 21, 22Laceration repair is indicated when PPH is a result of genital tract trauma. Surgical options when other measures fail to control bleeding include curettage, uterine and other pelvic artery ligation, uterine compression sutures, and hysterectomy.14, 19, 21, 22More invasive procedures (e.g., uterine balloon tamponade and uterine artery embolization) and surgical techniques are generally used after “first-line” conservative management (e.g., uterotonics, uterine massage, bimanual compression, manual placenta and clot removal, and laceration repair) has failed to control bleeding and can be considered “second-line” interventions.28Procedures and surgeries can increase the risk of infection and other complications, and they may eliminate or adversely affect future fertility and pregnancy.
What is the best medication for postpartum hemorrhage?
Intravenous oxytocin is the drug of choice for postpartum hemorrhage. Ergotamine may also be used.
What is the protocol for postpartum bleeding?
Protocols to manage postpartum bleeding are recommended to ensure the rapid giving of blood products when needed. A detailed stepwise management protocol has been introduced by the California Maternity Quality Care Collaborative. It describes 4 stages of obstetrical hemorrhage after childbirth and its application reduces maternal mortality.
How much blood loss is normal after birth?
Depending on the source, primary postpartum bleeding is defined as blood loss in excess of 500 ml following vaginal delivery or 1000 ml following caesarean section in the first 24 hours following birth. Secondary postpartum bleeding is that which occurs after the first day and up to six weeks after childbirth.
What causes postpartum hemorrhage?
Causes of postpartum hemorrhage are uterine atony, trauma, retained placenta or placental abnormalities, and coagulopathy, commonly referred to as the "four Ts": Tone: uterine atony is the inability of the uterus to contract and may lead to continuous bleeding.
When to use oxytocin after delivery?
Oxytocin is typically used right after the delivery of the baby to prevent PPH. Misoprostol may be used in areas where oxytocin is not available. Early clamping of the umbilical cord does not decrease risks and may cause anemia in the baby, thus is usually not recommended.
What causes bleeding in the placenta?
Tissue: retention of tissue from the placenta or fetus as well as placental abnormalities such as placenta accreta and percreta may lead to bleeding.
Why do we massage the uterus?
Uterine massage is a simple first line treatment as it helps the uterus to contract to reduce bleeding. Although the evidence around the effectiveness of uterine massage is inconclusive, it is common practice after the delivery of the placenta.