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n Obstetrics and Gynaecology Forum - Medical treatment of postpartum haemorrhage : review
Postpartum haemorrhage (PPH) may occur unexpectedly in any woman who has given birth. All birth attendants must have the skills and knowledge to manage PPH quickly and effectively. This may include rubbing up the uterus and bimanual compression, resuscitation, removal of retained placental tissue and surgical procedures.
The use of drugs to contract the uterus, and to enhance coagulation, are one element in the holistic management. The following sequence of drugs may be used :
Used by midwife :
1. If not recently given as prophylaxis and drip not yet up, oxytocin 10u im
2. Iv infusion oxytocin 20u in 1000ml Ringers lactate or saline at 120-240 mL/hour
3. Ergometrine 0.5mg or syntometrine 1 amp IMI provided no hypertension or cardiac disease [repeat once if needed]
Used by medical officer :
4. In women with hypertension or cardiac disease who continue to bleed with atonic uterus despite oxytocin, the risks versus benefits of ergometrine need to be weighed up.
5. Prostaglandin F2α 5mg in 10ml saline, inject 1ml into myometrium, checking carefully that not injecting into a blood vessel
6. Cyclokapron 1g slowly intravenously
7. Misoprostol 400µg sublingually or 600µg per rectum may be considered in the following circumstances :
1. When no oxytocin or ergometrine is available (eg unplanned home birth)
2. When all other methods have failed (although there is no evidence of benefit when injectable uterotonics have been given)
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